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Incidence of sedation-related adverse events during ERCP with anesthesia assistance: a multicenter observational study

Published:April 02, 2022DOI:https://doi.org/10.1016/j.gie.2022.03.023

      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

      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)
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