Background and Aims
Anesthesia assistance is commonly used for ERCP. General anesthesia (GA) may provide
greater airway protection but may lead to hypotension. We aimed to compare GA versus
sedation without planned intubation (SWPI) on the incidence of hypoxemia and hypotension.
We also explored risk factors for conversion from SWPI to GA.
Methods
This observational study used data from the Multicenter Perioperative Outcomes Group.
Adults with American Society of Anesthesiologists physical status class I to IV undergoing
ERCP between 2006 and 2019 were included. We compared GA and SWPI on incidence of
hypoxemia (oxygen saturation <90% for ≥3 minutes) and hypotension (mean arterial pressure <65 mm
Hg for ≥5 minutes) using joint hypothesis testing. The association between anesthetic
approach and outcomes was assessed using logistic regression. The noninferiority delta
for hypoxemia and hypotension was an odds ratio of 1.20. One approach was deemed better
if it was noninferior on both outcomes and superior on at least 1 outcome. To explore
risk factors associated with conversion from SWPI to GA, we constructed a logistic
regression model.
Results
Among 61,735 cases from 42 institutions, 38,830 (63%) received GA and 22,905 (37%)
received SWPI. The GA group had 1.27 times (97.5% confidence interval, 1.19-1.35)
higher odds of hypotension but .71 times (97.5% confidence interval, .63-.80) lower
odds of hypoxemia. Neither group was noninferior to the other on both outcomes. Conversion
from SWPI to GA occurred in 6.5% of cases and was associated with baseline comorbidities
and higher institutional procedure volume.
Conclusions
GA for ERCP was associated with less hypoxemia, whereas SWPI was associated with less
hypotension. Neither approach was better on the combined incidence of hypotension
and hypoxemia.
Graphical abstract
Graphical Abstract
Abbreviations:
ASA (American Society of Anesthesiologists), ASD (absolute standardized difference), AUC (area under the curve), CI (confidence interval), GA (general anesthesia), IPTW (inverse probability of treatment weighting), IQR (interquartile range), LASSO (least absolute shrinkage and selection operator), MAP (mean arterial pressure), MPOG (Multicenter Perioperative Outcomes Group), SpO2 (oxygen saturation), SRAE (sedation-related adverse event), SWPI (sedation without planned intubation)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 02, 2022
Accepted:
March 25,
2022
Received:
January 16,
2022
Footnotes
DISCLOSURE: The following author disclosed financial relationships: J. J. Vargo: Consultant for Olympus America and Aspero Medical; advisory board for Docbot. All other authors disclosed no financial relationships. Funding was provided by departmental and institutional resources at each contributing site. In addition, partial funding to support underlying electronic health record data collection into the Multicenter Perioperative Outcomes Group registry was provided by Blue Cross Blue Shield of Michigan/Blue Care Network as part of the Blue Cross Blue Shield of Michigan/Blue Care Network Value Partnerships program. Although Blue Cross Blue Shield of Michigan/Blue Care Network and Multicenter Perioperative Outcomes Group work collaboratively, the opinions, beliefs, and viewpoints expressed by the authors do not necessarily reflect the opinions, beliefs, and viewpoints of Blue Cross Blue Shield of Michigan/Blue Care Network or any of its employees. Funding for statistical support for this analysis was provided by the Anesthesiology Institute at Cleveland Clinic.
DIVERSITY, EQUITY, AND INCLUSION: One or more of the authors of this paper self-identifies as an under-represented gender minority in science.
If you would like to chat with an author of this article, you may contact Dr Cummings at [email protected]
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© 2022 by the American Society for Gastrointestinal Endoscopy
