Post written by Linda C. Cummings, MD, from the Division of Gastroenterology and Liver Disease, Department of Medicine, University Hospitals Cleveland Medical Center, and the Department of Medicine, Case Western Reserve University School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.

Our study used anesthetic case data from a multicenter consortium to compare 2 anesthetic approaches (general anesthesia and sedation) for ERCP on the combined incidence of hypoxemia and hypotension.

The optimal sedation approach for ERCP is unclear. General anesthesia provides better airway protection but can lead to hypotension. 

We identified 61,735 ERCP cases performed with anesthesia assistance from 42 institutions; 38,380 (63%) received general anesthesia, and 22,905 (37%) received sedation. General anesthesia was associated with greater hypotension (odds ratio [OR], 1.27; 97.5% confidence interval [CI], 1.19-1.35) but less hypoxemia (OR, .71; 97.5% CI, .63-.80). Neither sedation approach was better on the combined incidence of hypoxemia and hypotension. 

Our robust sample size also enabled us to identify risk factors for conversion from sedation to general anesthesia. Paralysis and hypertension were associated with conversion to general anesthesia. Because of missing information, we were unable to evaluate patient position as a risk factor for sedation-related adverse events. 

Ideally, the next step would be a randomized controlled trial evaluating these sedation approaches that uses these same endpoints (rather than less-rigorous endpoints such as use of airway maneuvers) and allows examination of the potential impact of patient position.

Graphical Abstract

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