Kemal Tolga SARAÇOĞLU, Banu ÇEVİK, Özlem SEZEN

Endoskopik Retrograd Kolanjiyo Pankreatografi İçin Analjezi Bazlı ve Konvansiyonel Sedasyon Teknikleri

GİRİŞ ve AMAÇ: Endoskopik retrograd kolanjiyopankreatografi (ERCP) ağrılı bir girişimdir ve genellikle anestezik uygulamalar gerektirir. Bu işlem sırasında işlemsel sedasyon için birçok ilaç kombinasyonu çalışılmıştır ve sonuçlar değişkenlik göstermektedir. Bu çalışmada remifentanil monoterapisini ERCP sırasındaki geleneksel sedasyon yöntemleriyle klinik güvenlik, derlenme profilleri, hasta ve endoskopist memnuniyeti açısından karşılaştırmayı amaçladık. YÖNTEM ve GEREÇLER: 18-80 yaşları arasındaki altmış hasta, işlemsel sedasyon için, remifentanil monoterapisi (bolus remifentanilin ardından infüzyon) ve geleneksel yöntemler (fentanil ile kombine edilmiş protafol ve / veya ketamin) olmak üzere rastgele iki gruba ayrıldı. Klinik özellikler, Ramsey Sedasyon Skoru (RSS), derlenme skoru (modifiye Aldrete skoru), hasta ve endoskopist memnuniyeti ölçülen sonuçlar olarak kabul edildi. BULGULAR: Her iki hasta grubunda da kardiyorespiratuar parametreler ve advers reaksiyonlar benzerdi. Hasta ve endoskopist memnuniyeti, RSS ve derlenme özellikleri remifentanil monoterapisi ile anlamlı derecede daha iyiydi. TARTIŞMA ve SONUÇ: Tek başına remifentanilin kullanılması, ERCP'de işlemsel sedasyon sırasında güvenli klinik performansı ve daha iyi sedasyon seviyesi, derlenme süresi ve memnuniyet sağlaması nedeniyle tercih edilen alternatif bir tedavi olarak düşünülebilir.

Analgesia-based vs Conventional Sedation Techniques For Endoscopic Retrograde Cholangiopancreatography: State of The Art

INTRODUCTION: Endoscopic retrogradecholangiopancreatography (ERCP) is a painful interventionand usually requires anesthetic implications. Many drugcombinations have been studied for procedural sedation duringthis procedure and the results show variability. In this study,we aimed to compare the remifentanil monotherapy with theconventional sedation methods during ERCP in terms ofclinical security, recovery profiles and the satisfaction of thepatients and endoscopists.METHODS: Sixty patients aged between 18-80 years wererandomly allocated into two groups to receive eitherremifentanil monotherapy (bolus dose of remifentanil followedby infusion) or conventional methods (propofol and/orketamine combined with fentanyl) for procedural sedation.Clinical characteristics, Ramsey Sedation Score (RSS),recovery score (modified Aldrete score), the satisfaction ofpatients and endoscopists were considered as measuredoutcomes.RESULTS: The cardiorespiratory parameters and adversereactions were similar in both groups of patients. Theendoscopist and patent satisfaction, RSS and recoverycharacteristics were significantly better with remifentanilmonotherapy.DISCUSSION AND CONCLUSION: The usage ofremifentanil alone may be considered as an alternativetreatment of choice during procedural sedation in ERCP due toits safety clinical performance and providing better sedationlevel, recovery period and satisfaction.

PDF

___

1. Smith A, Silvestro L, Rodriguez RE, Austin PN. Evidence- Based Selection of Sedation Agents for Patients Undergoing Endoscopic Retrograde Cholangiopancreatography. Gastroenterol Nurs 2016 Jan-Feb; 39(1):32-41. doi: 10.1097/SGA.0000000000000195.
2. ASGE Standards of Practice Committee, Early DS, Lightdale JR, Vargo JJ 2nd, Acosta RD, Chandrasekhara V, Chathadi KV, Evans JA, Fisher DA, Fonkalsrud L, Hwang JH, Khashab MA, Muthusamy VR, Pasha SF, Saltzman JR, Shergill AK, Cash BD, DeWitt JM. Guidelines for sedation and anesthesia in GI endoscopy. GastrointestEndosc 2018; 87: 327-337. doi: 10:1016/). Gie.2017.07.018 Epub2018Jan3.
3. Joshi D, Paranandi B, El Sayed G, Down J, Johnson GJ, Chapman MH, et al. Experience of propofol sedation ina UK ERCP practice: lessons for service provision. Frontline Gastroenterol 2015 ; 6(1):32-37.
4. Haffar S, Kaur RJ, Garg SK, Hyder JA, Murad MH, Abu Dayyeh BK, et al. Acute pancreatitis associated with intravenous administration of propofol: evaluation of causalityin a systematic review of the literature. Gastroenterol Rep (Oxf) 2019 ; 7(1):13-23.
5. Yang JF, Farooq P, Zwilling K, Patel D, Siddiqui AA. Efficacy and Safety of PropofolMediated Sedation for Outpatient Endoscopic Retrograde Cholangiopancreatography (ERCP). Dig Dis Sci 2016; 61(6):1686-91.
6. Smith ZL, Das KK, Kushnir VM. Anesthesiaadministered sedation for endoscopic retrograde cholangiopancreatography: monitored anesthesia care or general endotracheal anesthesia? Curr Opin Anaesthesiol 2019 ;32(4);531-537.
7. Michelsen LG, Hug CCJr. The pharmacokinetics of remifentanil. J Clin Anesth1996; 8(8):679-82.
8. Rudner R, Jalowiecki P, Kawecki P, Gonciarz M, Mularczyk A, Petelenz M. Conscious analgesia/sedation with remifentanil and propofol versus total intravenous anesthesia with fentanyl, midazolam and propofol for outpatient colonoscopy. GastrointestEndosc 2003; 57(6): 657-63.
9. 9.https://www.random.org/(Access date: 04/04/2019)
10. Ronen M, Weissbrod R, Overdyk FJ, Ajizian S. Smart respiratory monitoring: Clinical development and validation of IPI™ (Integrated Pulmonary Index) algorithm. J ClinMonitComput 2017; 31(2):435-42.
11. American Society of Anesthesiologists. Continuum of depth of sedation. Available from http://www.asahq.org (accessed 14/04/ 2019)
12. Aldrete JA. The post-anesthesia recovery score revisited. J ClinAnesth 1995; 7:89-91.
13. Shin S, Oh TG, Chung MJ, Park JY, Park SW, Chung JB et al. Conventional versus analgesiaoriented combination sedation on recovery profiles and satisfaction after ERCP: A randomized trial. PLoS ONE 2015; 24,10(9): e 0138422.
14. Cousins MJ. Monitoring-the anaesthesist’s view. Scand J Gastroenterol Suppl volume 25 1990; 179: 12-17.
15. Raymondos K, Panning B, Bachem I, Manns MP, Piepenbrock S, Meier PN. Evaluation of endoscopic retrograde cholangiopancreatography under conscious sedation and general anesthesia. Endoscopy 2002; 34(9):721-26.
16. Patel S, Vargo JJ, Khandwala F, Lopez R, Trolli P, Dumot JA, et al. Deep sedation occurs frequently during elective endoscopy with meperidine and midazolam. Am J Gastroenterol 2005; 100(12): 2689-95.
17. Chen LH, Liang J, Chen MC, Wu CC, Cheng HS, Wang HH, et al. The relationship between preoperative American Society of Anesthesiologists Physical Status Classification scores and functional recovery following hip-fracture surgery. BMC Musculoskelet Disord. 2017 Oct 10;18(1):410. doi: 10.1186/s12891-017-1768-x.
18. Jeurnink SM, Steyerberg E, Kuipers E, Siersema P. The burden of endoscopic retrograde cholangiopancreatography (ERCP) performed with the patient under conscious sedation Surg Endosc 2012; 26(8):2213-19.
19. Shin S, Lee SK, Min KT, Kim HJ, Park CH, Yoo YC. Sedation for interventional gastrointestinal endoscopic procedures: are we overlooking the “pain”? Surgical Endoscopy 2014; 28(1):100-107. doi: 10.1007/s00464-013-3133-y.
20. Akhondzadeh R, Ghomeishi A, Nesioonpour S, Nourizade S. A comparison between the effects of propofol-fentanyl with propofol-ketamine for sedation in patients undergoing endoscopic retrograde cholangiopancreatography outside the operating room. Biomedical Journal 2016; 39(2):145-9.
21. Jensen JT, Vilmann P, Konge L, Møller. Safety and efficacy of remifentanil for single agent procedural sedation: A systematic review. Int J Anesthetic Anesthesiol 2015;2:033.
22. Heidari SM, Longhmani P. Assessment of the effects of ketamine-fentanyl combination versus propofol-remifentanil combination for sedation during endoscopic retrograde cholangiopancreatography. J Res Med Sci 2014; 19 (9):860-6.
23. Chainaki IG, Manolaraki MM, Paspatis GA. Deep sedation for endoscopic retrograde cholangiopancreatography. World J Gastrointes Endosc 2011;16; 3 (2): 34-9.