Consensus guidelines for the perioperative management of patients undergoing endoscopic retrograde cholangiopancreatography
Issued Date
2023-01-01
Resource Type
ISSN
00070912
eISSN
14716771
Scopus ID
2-s2.0-85152690774
Pubmed ID
37062671
Journal Title
British Journal of Anaesthesia
Rights Holder(s)
SCOPUS
Bibliographic Citation
British Journal of Anaesthesia (2023)
Suggested Citation
Azimaraghi O., Bilal M., Amornyotin S., Arain M., Behrends M., Berzin T.M., Buxbaum J.L., Choice C., Fassbender P., Sawhney M.S., Sundar E., Wongtangman K., Leslie K., Eikermann M. Consensus guidelines for the perioperative management of patients undergoing endoscopic retrograde cholangiopancreatography. British Journal of Anaesthesia (2023). doi:10.1016/j.bja.2023.03.012 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/82509
Title
Consensus guidelines for the perioperative management of patients undergoing endoscopic retrograde cholangiopancreatography
Author's Affiliation
Siriraj Hospital
University of Minnesota Twin Cities
University of California, San Francisco
Marien Hospital Herne
Monash University
Keck School of Medicine of USC
Universitätsklinikum Essen
Royal Melbourne Hospital
Harvard Medical School
Albert Einstein College of Medicine of Yeshiva University
Center for Interventional Endoscopy
University of Minnesota Twin Cities
University of California, San Francisco
Marien Hospital Herne
Monash University
Keck School of Medicine of USC
Universitätsklinikum Essen
Royal Melbourne Hospital
Harvard Medical School
Albert Einstein College of Medicine of Yeshiva University
Center for Interventional Endoscopy
Other Contributor(s)
Abstract
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. Using a modified Delphi approach, the group created practical recommendations for anaesthesiologists, with the aim of reducing the incidence of perioperative adverse outcomes while maximising 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.