What is it about?
The international expert panel concludes that monitored anaesthesia care is the favoured anaesthesia plan for ERCP. However, an individual risk-benefit analysis that takes into account provider and institutional experience, patient comorbidities, and procedural risks is needed for each case. There are no universal quality metrics for provision of anaesthesia for ERCP. Finally, the anaesthesia plan should also be made based on institutional factors.
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Why is it important?
Using a modified Delphi approach, the group created practical recommendations for anaesthesiologists, with the aim of reducing the incidence of perioperative adverse outcomes while maximizing healthcare resource utilisation. In the majority of clinical scenarios analysed, our expert recommendations favour monitored anaesthesia care over general anaesthesia. Patients with increased risk of pulmonary aspiration and those undergoing prolonged procedures of high complexity were thought to benefit from general anaesthesia with tracheal intubation. Patient age and ASA physical status were not considered to be factors for choosing between monitored anaesthesia care and general anaesthesia. Monitored anaesthesia care is the favoured anaesthesia plan for ERCP. An individual risk-benefit analysis that takes into account provider and institutional experience, patient comorbidities, and procedural risks is also needed.
Perspectives
Deep sedation without tracheal intubation (monitored anaesthesia care) and general anaesthesia with tracheal intubation are commonly used anaesthesia techniques for endoscopic retrograde cholangiopancreatography (ERCP). There are distinct pathophysiological differences between monitored anaesthesia care and general anaesthesia that need to be considered depending on the nature and severity of the patient’s underlying disease, comorbidities, and procedural risks. An international group of expert anaesthesiologists and gastroenterologists created clinically relevant questions regarding the merits and risks of monitored anaesthesia care vs general anaesthesia in specific clinical scenarios for planning optimal anaesthetic approaches for ERCP.
Professor Somchai Amornyotin
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University
Read the Original
This page is a summary of: Consensus guidelines for the perioperative management of patients undergoing endoscopic retrograde cholangiopancreatography, British Journal of Anaesthesia, June 2023, Elsevier,
DOI: 10.1016/j.bja.2023.03.012.
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