Two Cardiac Arrests Because of Venous Air Embolism During Endoscopic Retrograde Cholangiopancreatography: A Case Report
We report 2 cases of venous air embolism and subsequent cardiac arrests. During resuscitation efforts, a transesophageal echocardiogram was placed, which demonstrated significant air in the right heart. Although gastroenterologists seem to be more aware of this complication, it is underreported in the anesthesiology literature. As anesthesiologists continue to expand coverage to endoscopy suites, anesthesia providers must be aware of predisposing factors and maintain a high index of suspicion to recognize and treat in a timely manner to prevent serious adverse outcomes.
We appreciate the remarks by Perisetti et al1 and their interest in our recent study.2 The authors pointed out that general endotracheal anesthesia is related to lower sedation-related adverse events. According to a recent study by Smith et al,3 in patients at high risk for sedation-related adverse events undergoing ERCP, sedation with g eneral endotracheal anesthesia is associated with a significantly lower incidence of sedation-related adverse events without any impact on procedure duration, success, recovery, or in-room time.
Purpose of review The decision to undertake monitored anesthesia care (MAC) or general endotracheal anesthesia (GEA) for patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) is influenced by many factors. These include locoregional practice preferences, procedure complexity, patient position, and comorbidities. We aim to review the data regarding anesthesia-administered sedation for ERCP and identify the impact of airway management on procedure success, adverse event rates and endoscopy unit efficiency. Recent findings Several studies have consistently identified patients at high risk for sedation...
The proper training in sedation and who should administer it during ERCP still unknown.
Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used in the treatment of pancreato-biliary disease. Despite advances in technique and equipment, ERCP complications occur and can be significant. ERCP is traditionally performed with patients in prone position (PP). However, this poses a potentially increased risk of anaesthetic complications. An alternative position is the left lateral decubitus (LL) position, which is the most common position for endoscopic procedures. As there is currently no data comparing LL with PP and their success and complication rates, we conducted a study to show that LL positi...
The use of anesthesia for ERCP has evolved substantially in recent years. Historically, ERCP was performed with the use of moderate (conscious) sedation administered by gastroenterologists using opiates, analgesics, or long-acting benzodiazepines, with or without adjunctive agents such as droperidol or diphenhydramine. The use of conscious sedation for ERCP has largely been abandoned. The longer procedure times associated with ERCP lead to greater cumulative doses of benzodiazepines and opiates to maintain adequate sedation.
We read with interest the article by Bukhari et al1 on a comparative trial of EUS-guided gastrogastrostomy-assisted ERCP (EUS-GG-ERCP) versus enteroscopy-assisted ERCP (e-ERCP) in patients with Roux-en-Y gastric bypass (RYGB) under general anesthesia. In EUS-GG-ERCP, a duodenoscope was passed through the gastrogastrostomy (GG) created by a lume n-apposing metallic stent (LAMS) into the excluded stomach. Although the authors concluded that EUS-GG-ERCP may be superior to e-ERCP in RYGB patients, the main drawback of EUS-GG-ERCP is to require 4 procedural sessions (GG creation, ERCP, LAMS removal with GG closure, and co...
We read with interest the article by Abbas et al1 on a large multicenter study of laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass (RYGB) because of the impossibility of performing standard ERCP. They reported their outcomes after laparoscopic access to the remnant stomach with the patient under general anesthesia. The duod enoscope was inserted through the indwelling trocar into the stomach. ERCP was performed with 98% diagnostic success, 98% therapeutic success, and 18% adverse events (92% mild/moderate and 8% severe).
ERCP is a complex procedure and often performed in patients at high risk for sedation-related adverse events (SRAE). However, there is no current standard of care with regard to mode of sedation and airway management during ERCP. The aim of this study was to assess the safety of general endotracheal anesthesia (GEA) versus propofol-based monitored anesthesia care without endotracheal intubation (MAC) in patients undergoing ERCP at high risk for SRAE.
ERCP is a complex procedure and often performed in patients at high risk for sedation-related adverse events (SRAEs). However, there is no current standard of care with regard to mode of sedation and airway management during ERCP. The aim of this study was to assess the safety of general endotracheal anesthesia (GEA) versus propofol-based monitored anesthesia care (MAC) without endotracheal intubation in patients undergoing ERCP at high risk for SRAEs.
Conclusions Ocular-radiation exposure to ERCP personnel was one-third lower in the prone than in LLD position. Therefore, more annual ERCPs could be performed by the personnel. [...] © Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents | Abstract | open access Full text