• Sheila Ryan Barnett, Tyler Berzin, Sirish Sanaka, Douglas Pleskow, Mandeep Sawhney, and Ram Chuttani.
• Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA, sbarnett@bidmc.harvard.edu.
• Dig. Dis. Sci. 2013 Nov 1; 58 (11): 3287-92.

BackgroundProviding the appropriate anesthesia for endoscopic retrograde cholangiopancreatography (ERCP) cases is challenging.AimThe aim of our study was to prospectively assess the safety of anesthesia directed deep sedation (ADDS) in non-intubated patients compared to general endotracheal anesthesia (GET) during an ERCP.MethodsWe conducted a prospective observational study in patients undergoing an ERCP. The choice of anesthetic-ADDS or GET-was made by the anesthesiologist. The pre-anesthesia assessment, intraoperative vital signs, and medications administered were collected. A standardized study instrument was used to record the number of procedure interruptions, intraprocedure and recovery room adverse events (AE).ResultsA total of 393 (89.7 %) patients received ADDS (no intubation) and 45 (10.2 %) received a GET. Age and comorbidities were similar in ADDS and GET groups. BMI was higher in the GET (32.6 ± 9.5) versus in the ADDS (27.3 ± 6.1) group; p < 0.001. The number of ASA 2 patients was higher in the ADDS versus the GET group (38.7 versus 22.2 %; p < 0.04); the number of ASA 4 patients was 15.6 % of GET versus 6.6 % of the ADDS cases (p = 0.05). During the procedure 16 (3.7 %) ADDS patients were intubated and converted to a GET anesthetic; 4 (25 %) of the converted ADDS cases were ASA 4 versus 6.4 % of ADDS patients (p = 0.006). Intraprocedure events occurred in 35.6 % of GET and 25.7 % of ADDS cases, without significant complications.ConclusionOur data suggest that the administration of anesthesia without intubation for prone ERCP cases is feasible especially in non-obese, healthier patients.

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