Bülent BALTACI, Hülya BAŞAR, Murat KEKİLLİ, Mert NAKİP, Fatih KARAAHMET, Mehmet ÇAKIRCA, Melis ENGİN, Meltem BEKTAŞ

Effect of sevoflurane anaesthesia on nasal mask in endoscopic retrograde cholangiopancreatography: is it a preferred alternative?

Background/aim: Endoscopic retrograde cholangiopancreatography ERCP often requires deep sedation. Propofol provides adequate sedation and amnesia at subhypnotic doses, but safe guarding the patient's airway is important for preventing respiratory depression or hypoxic events. This study compared sedation levels, operator satisfaction, intraoperative and recovery characteristics using sevoflurane with nasal mask and propofol in ERCP. Material and methods: Sixty-one patients underwent ERCP Group I: propofol, n = 31; Group II, sevoflurane, n = 30 , with sedation controlled by the Ramsay sedation scale RSS . The patients' demographic data, procedure length, overall drug dose, hemodynamic changes, duration of recovery and Aldrete scores during recovery were evaluated. In addition, satisfaction of the gastroenterologist was evaluated. Results: The mean sphincterotomy satisfaction scores were statistically significant P= 0.043 . The Aldrete scores and RSS of the groups were similar; there was a significant difference between groups at the beginning of the procedure regarding peripheric oxygen saturations and Group II's saturation levels increased during sedation. Conclusion: In ERCP, propofol infusion provides shorter recovery duration and adequate sedation levels. Sevoflurane and oxygen with a nasal mask can be chosen to generate specific anaesthesia in patients, especially for strong airway support and safety treating hypoxemic patients.

Keywords:

Sedation, endoscopic retrograde cholangiopancreatography, sevoflurane, nasal mask,

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1. ASGE Ensuring Safety in the Gastrointestinal Endoscopy Unit Task Force, Calderwood AH, Chapman FJ, Cohen J, Cohen LB, Collins J et al. Guidelines for safety in the gastrointestinal endoscopy unit. Gastrointestinal Endoscopy 2014;79 (3): 363- 372. doi: 10.1016/j.gie.2013.12.015. Epub 2014 Jan 28
2. Chi SI. Complications caused by nitrous oxide in dental sedation. Journal of Dental Anesthesia and Pain Medicine 2018; 18 (2): 71-78. doi: 10.17245/jdapm.2018.18.2.71
3. Porhomayon J, Zadeii G, Nader ND, Bancroft GR, Yarahamadi A. Application of dual mask for postoperative respiratory support in obstructive sleep apnea patient. Case Reports in Anesthesiology 2013; 2013: 321054. doi: 10.1155/2013/321054. Epub 2013 Apr 10.
4. Raymondos K, Panning B, Bachem I, Manns MP, Piepenbrock S et al. Evaluation of endoscopic retrograde cholangiopancreatography under conscious sedation and general anesthesia. Endoscopy 2002; 34 (9): 721-726. doi: 10.1055/s-2002-33567
5. Church NI, Seward EW, Pereira SP, Hatfield AR., Webster GJ. Success of Repeat ERCP Following Initial Therapeutic Failure. Gastrointestinal Endoscopy 2006; 63 (5), AB293. doi:10.1016/j.gie.2006.03.771
6. Cheriyan DG, Byrne MF. Propofol use in endoscopic retrograde cholangiopancreatography and endoscopic ultrasound. World Journal of Gastroenterology 2014; 20 (18): 5171-5176. doi: 10.3748/wjg.v20.i18.5171
7. Liu H, Waxman DA, Main R, Mattke S. Utilization of anesthesia services during outpatient endoscopies and colonoscopies and associated spending in 2003-2009. Journal of American Medical Association 2012; 307 (11): 1178-1184. doi: 10.1001/ jama.2012.270.
8. Predmore Z, Nie X, Main R, Mattke S, Liu H. Anesthesia service use during outpatient gastroenterology procedures continued to increase from 2010 to 2013 and potentially discretionary spending remained high. American Journal of Gastroenterology 2017;112 (2): 297-302. doi: 10.1038/ ajg.2016.266. Epub 2016 Jun 28
9. Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy, Lichtenstein DR, Jagannath S, Baron TH, Anderson MA et al. Sedation and anesthesia in GI endoscopy. Gastrointestinal Endoscopy 2008; 68 (5): 815-826. 10.1016/j.gie.2008.09.029
10. Song JG, Cao YF, Sun YM, Ge YH, Xu XW et al. Baroreflex sensitivity is impaired in patients with obstructive jaundice. Anesthesiology 2009; 111 (3): 561-565. 10.1097/ ALN.0b013e3181adf49f
11. Lim YS, Kang DH, Kim SH, Jang TH, Kim KH et al. The cardiovascular effects of midazolam co-induction to propofol for induction in aged patients. Korean Journal of Anesthesiology 2012; 62 (6): 536-542. doi: 10.4097/kjae.2012.62.6.536
12. Schumann R, Natov NS, Rocuts-Martinez KA, Finkelman MD, Phan TV et al. High-flow nasal oxygen availability for sedation decreases the use of general anesthesia during endoscopic retrograde cholangiopancreatography and endoscopic ultrasound. World Journal of Gastroenterology 2016; 22 (47): 10398-10405. doi: 10.3748/wjg.v22.i47.10398
13. Gomes HS, Gomes HS, Sado-Filho J, Costa LR, Costa PS. Does sevoflurane add to outpatient procedural sedation in children? A randomised clinical trial. BioMed Central Pediatrics 2017; 17 (1): 86. doi: 10.1186/s12887-017-0838-4
14. Yamakage M, Namiki A. Cellular mechanisms of airway smooth muscle relaxant effects of anesthetic agents. Journal of Anesthesia 2003; 17 (4): 251-258. doi: 10.1007/s00540-003- 0194-4
15. Mondonedo JR, McNeil JS, Amin SD, Herrmann J, Simon BA et al. Volatile anesthetics and the treatment of severe bronchospasm: a concept of targeted delivery. Drug Discovery Today Disease Models 2015; 15: 43-50. doi: 10.1016/j. ddmod.2014.02.004
16. Montes RG, Bohn RA. Deep sedation with inhaled sevoflurane for pediatric outpatient gastrointestinal endoscopy. Journal of Pediatric Gastroenterology and Nutrition 2000; 31 (1): 41-46. doi: 10.1097/00005176-200007000-00010
17. Sharma VK, Nguyen CC, Crowell MD, Lieberman DA, de Garmo P et al. A national study of cardiopulmonary unplanned events after GI endoscopy. Gastrointestinal Endoscopy 2007; 66 (1): 27-34. doi: 10.1016/j.gie.2006.12.040
18. Griffin SM, Chung SC, Leung JW, Li AK. Effect of intranasal oxygen on hypoxia and tachycardia during endoscopic cholangiopancreatography. British Medical Journal 1990; 300 (6717): 83-84. doi: 10.1136/bmj.300.6717.83
19. Aldrete JA. The post-anesthesia recovery score revisited. Journal of Clinical Anesthesiology 1995; 7 (1): 89-91. doi: 10.1016/0952-8180(94)00001-k