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Perspective - Journal of Anesthetics and Anesthesiology (2023) Volume 5, Issue 3
Anaesthesia sedation guidelines for endoscopic retrograde cholangiopancreatography
Michel Bluementhal *
Department of Obstetric Anesthesia
- *Corresponding Author:
- Michel Bluementhal
Department of Anaesthesiology
Orthopedic University Clinic Balgrist
Forchstrasse, Zurich, Switzerland
E-mail: michel39@balgrist.ch
Received:29-May-2023, Manuscript No. AAAA-23-103216; Editor assigned:01-June-2023, PreQC No. AAAA-23-103216 (PQ); Reviewed:15-Jun-2023 , QC No. AAAA-23-97651; Revised:19-Jun-2023, Manuscript No. AAAA-23-103216 (R); Published:26-Jun-2023, DOI:10.35841/ aaaa-5.3.146
Citation: Bluementhal M. Anaesthesia sedation guidelines for endoscopic retrograde cholangiopancreatography. J Anesthetic Anesthesiol. 2023;5(3):146
Abstract
Sedation and analgesia are critical components of endoscopic operations. They help to improve patient tolerance and compliance by reducing pain, discomfort, and stress in patients undergoing unpleasant and lengthy procedures like Endoscopic Retrograde Cholangiopacreatography (ERCP). Furthermore, they lessen the risk of injury during ERCP due to inadvertent co-operation and make the endoscopist's job easier. Endoscopic retrograde cholangiopancreatography (ERCP) patients require appropriate sedation or general anaesthesia. There is currently no agreement on who should deliver sedative to these patients. Several researches have looked into the safety and efficacy of non-anesthesiologist-administered sedation for ERCP; however, data on anaesthesiologist-administered sedation is few. This prospective single-center study looked into the safety and efficacy of anaesthesiologist-administered sedation, as well as the success rate of ERCP procedures.
Abstract
Sedation and analgesia are critical components of endoscopic operations. They help to improve patient tolerance and compliance by reducing pain, discomfort, and stress in patients undergoing unpleasant and lengthy procedures like Endoscopic Retrograde Cholangiopacreatography (ERCP). Furthermore, they lessen the risk of injury during ERCP due to inadvertent co-operation and make the endoscopist's job easier. Endoscopic retrograde cholangiopancreatography (ERCP) patients require appropriate sedation or general anaesthesia. There is currently no agreement on who should deliver sedative to these patients. Several researches have looked into the safety and efficacy of non-anesthesiologist-administered sedation for ERCP; however, data on anaesthesiologist-administered sedation is few. This prospective single-center study looked into the safety and efficacy of anaesthesiologist-administered sedation, as well as the success rate of ERCP procedures.
Key words
Cholangiopancreatography, Endoscopist, Capnography, Anaesthesiologists, Analgesia, Anxiolyis.
Introduction
Sedation is defined as a continuum of progressive impairment in consciousness ranging from minimal to moderate, deep sedation, and general anaesthesia by the American Society of Anaesthesiologists (ASA). This continuum represents the idea that patients can shift fluidly between sedation stages. Furthermore, transitioning from a state of consciousness to deep sedation is a dose-related continuum that is dependent on patient reaction; hence, the condition planned may not be the one finally reached. This is because the pharmacokinetics and pharmacodynamics of sedative medications vary greatly. As a result, a typical sedative dose may result in under sedation in certain persons and over sedation in others [1].
Capnography is a well-studied anaesthesia technology that has been utilised in the operating room for over 35 years. Capnography was first used as a research technique by anaesthesiologists and respiratory physiologists in the 1950s. After the invention of mass spectroscopy in the 1940s, modern capnography was developed and commercialised in the 1960s and 1970s. Capnography became a routine feature of anaesthesia practise in Europe in the 1970s and in the United States in the 1980s thanks to the pioneering work of Smalhout and Kalenda. The American Society of Anaesthesiologists published Standards for Basic Anaesthetic Monitoring in 1999, outlining the function of capnography for all patients undergoing general anaesthesia: "Every patient undergoing general anaesthesia shall have the adequacy of ventilation continuously evaluated." Qualitative clinical indicators such chest excursion, examination of the reservoir breathing bag, and auscultation of breath sounds are helpful. Unless invalidated by the nature of the patient, treatment, or equipment, continuous monitoring for the presence of expired carbon dioxide must be conducted [2].
Capnography is a well-studied anaesthesia technology that has been utilised in the operating room for over 35 years. Capnography was first used as a research technique by anaesthesiologists and respiratory physiologists in the 1950s. After the invention of mass spectroscopy in the 1940s, modern capnography was developed and commercialised in the 1960s and 1970s. Capnography became a routine feature of anaesthesia practise in Europe in the 1970s and in the United States in the 1980s thanks to the pioneering work of Smalhout and Kalenda. The American Society of Anaesthesiologists published Standards for Basic Anaesthetic Monitoring in 1999, outlining the function of capnography for all patients undergoing general anaesthesia: "Every patient undergoing general anaesthesia shall have the adequacy of ventilation continuously evaluated." Qualitative clinical indicators such chest excursion, examination of the reservoir breathing bag, and auscultation of breath sounds are helpful. Unless invalidated by the nature of the patient, treatment, or equipment, continuous monitoring for the presence of expired carbon dioxide must be conducted [3].
Here are some significant points frequently covered in ERCP anaesthesia sedation guidelines:
- Patient examination: A complete review of the patient's medical history, physical condition, and any comorbidities should be undertaken before to the treatment. This assessment aids in determining the optimal dose of sedation as well as identifying any potential dangers or contraindications.
- Sedation options: ERCP can be performed with various levels of sedation, ranging from little sedation (anxiolysis) to moderate sedation (conscious sedation) and deep sedation. Sedation should be customised to the needs of the particular patient and the procedure.
- Monitoring vital indicators such as heart rate, blood pressure, oxygen saturation, and breathing rate is critical during sedation. Capnography, which detects exhaled carbon dioxide, is also frequently advised for monitoring ventilation and detecting respiratory issues.
- Sedative agents: Guidelines may include suggestions for the selection and administration of sedative drugs. Benzodiazepines (such as midazolam), opioids (such as fentanyl), and propofol are all often utilised medications. The drug and dose regimen should be tailored to the patient's age, weight, and comorbidities.
- •Staff and training: Guidelines may stress the importance of having suitably trained healthcare staff administer and manage sedation during ERCP. Anaesthesiologists, nurse anaesthetists, and other certified healthcare providers with sedation training may be included.
- Recovery and discharge: Following the procedure, guidelines may establish criteria for patient recovery and safe discharge. Stable vital signs, recovery after anaesthesia, good pain control, and the capacity to tolerate oral food are typical criteria[4].
It should be noted that particular rules and suggestions may differ amongst professional groups and healthcare institutions. For the most reliable and up-to-date information on anaesthesia sedation for ERCP, it is best to study the most recent guidelines from reputable sources, such as professional organisations or published literature[5].
Conclusion
Sedation and analgesia are particularly difficult to provide because patients are frequently required to lie in the prone position, and any movement, coughing, or gagging during the intervention might hinder or possibly result in difficulties. It can be challenging for the operator to handle moderate or profound sedation while concentrating on the process. Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and therapeutic treatment that is frequently conducted in endoscopy suites rather than operating rooms and incorporates the use of gastroscopy and radiography at the same time. ERCP is invasive and can be uncomfortable, especially when bile duct dilatation for stenosis is performed, and the process may take longer than other endoscopic treatments
References
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- Martindale SJ. Anaesthetic considerations during endoscopic retrograde cholangiopancreatography.. Anaesth Intensive Care Pain Med. 2006;34(4):475-80.
- Raymondos K, Panning B, Bachem I, et al. Evaluation of endoscopic retrograde cholangiopancreatography under conscious sedation and general anesthesia . J Endosc. 2002;34(09):721-6.
- Wengrower D, Gozal D, Goldin E. Familial dysautonomia: deep sedation and management in endoscopic procedures.. Am J Gastroenterol. 2002;97(10):2550-2.
- Chen WX, Lin HJ, Zhang WF, et al. Sedation and safety of propofol for therapeutic endoscopic retrograde cholangiopancreatography.. Hepatobiliary Pancreat Dis Int. 2005;4(3):437-40.
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