title: Monitored anesthesia care without endotracheal intubation is safe and efficacious for single-balloon enteroscopy.
abstract: BACKGROUND
  General endotracheal (GET) anesthesia is often used during single-balloon enteroscopy (SBE). However, there is currently limited data regarding monitored anesthesia care (MAC) without endotracheal intubation for this procedure.
  
  
  OBJECTIVE
  The aim of the study was to determine the safety and efficacy of MAC sedation during SBE and to identify risk factors for adverse events.
  
  
  METHODS
  All patients who underwent SBE and SBE-assisted endoscopic retrograde cholangiopancreatography between June 2011 and July 2013 at a tertiary-care referral center were studied in a retrospective analysis of a prospectively collected database. Patients received MAC anesthesia or GET. The main outcome measurements were sedation-related adverse events, diagnostic yield, and therapeutic yield.
  
  
  RESULTS
  Of the 178 cases in the study, 166 cases (93 %) were performed with MAC and 12 (7 %) with GET. Intra-procedure sedation-related adverse events occurred in 17 % of cases. The most frequent event was transient hypotension requiring pharmacologic intervention in 11.8 % of procedures. In MAC cases, the diagnostic yield was 58.4 % and the therapeutic yield was 30.1 %. Anesthesia duration was strongly associated with the occurrence of a sedation-related adverse event (P = 0.005).
  
  
  CONCLUSIONS
  MAC is a safe and efficacious sedation approach for most patients undergoing SBE. Sedation-related complications in SBE are uncommon, but are more frequent in longer procedures.
authors.affiliation: Division of Gastroenterology, Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA, ssethi@bidmc.harvard.edu.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Sethi
authors.forename: Adarsh M
authors.initials: AM
authors.lastname: Thaker
authors.forename: Jonah
authors.initials: J
authors.lastname: Cohen
authors.forename: Sagar
authors.initials: S
authors.lastname: Garud
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Sawhney
authors.forename: Ram
authors.initials: R
authors.lastname: Chuttani
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Pleskow
authors.forename: Sheila R
authors.initials: SR
authors.lastname: Barnett
authors.forename: Tyler M
authors.initials: TM
authors.lastname: Berzin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001145:Arrhythmias, Cardiac / Q000209:etiology; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods; D004066:Digestive System Diseases / Q000175:diagnosis / Q000628:therapy; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology; D000860:Hypoxia / Q000209:etiology; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D018686:Anesthetics, Intravenous