Effect of sevoflurane anaesthesia on nasal mask in endoscopic retrograde cholangiopancreatography: is it a preferred alternative?
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 adequatesedation and amnesia at subhypnotic doses, but safe guarding the patient’s airway is important for preventing respiratory depression orhypoxic events. This study compared sedation levels, operator satisfaction, intraoperative and recovery characteristics using sevofluranewith 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 sedationcontrolled by the Ramsay sedation scale (RSS). The patients’ demographic data, procedure length, overall drug dose, hemodynamicchanges, duration of recovery and Aldrete scores during recovery were evaluated. In addition, satisfaction of the gastroenterologist wasevaluated.Results: The mean sphincterotomy satisfaction scores were statistically significant (P= 0.043). The Aldrete scores and RSS of the groupswere similar; there was a significant difference between groups at the beginning of the procedure regarding peripheric oxygen saturationsand Group II’s saturation levels increased during sedation.Conclusion: In ERCP, propofol infusion provides shorter recovery duration and adequate sedation levels. Sevoflurane and oxygenwith a nasal mask can be chosen to generate specific anaesthesia in patients, especially for strong airway support and safety treatinghypoxemic patients.
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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