Endoscopic retrograde cholangiopancreatography (ERCP) can be conducted under monitored anaesthesia care (MAC) with the patient spontaneously breathing or general anaesthesia (GA) with endotracheal intubation. The choice of anaesthetic technique must consider the clinical setting, patient comorbidities and procedural complexity. However, there continues to be variation in practice between clinicians and institutions based on personal preference, experience and local hospital protocols. 

The aim of this study was to assess the incidence of anaesthetic related adverse events for patients undergoing GA with endotracheal intubation versus MAC for ERCP.

This study was reviewed by the Barwon Health Research Development Unit which determined the study meets the criteria for a Quality Assurance activity in accordance with the National Statement on Ethical Conduct in Human Research (QA/105104/VICBH-2024-409492).          

All adults (≥ 18 years of age) undergoing emergency and elective ERCP at University Hospital Geelong between 1st January to 31st December 2023 were screened for eligibility. Patients were excluded if they were intubated on arrival or had incomplete medical records. The primary outcomes were intraoperative hypotension, vasopressor use, hypoxia and aspiration. We used multivariable regression analysis to identify patient, anaesthetic and procedural factors associated with increased risk of anaesthetic related adverse events. 

Results: 

A total of 228 patients (mean age 66 ± 18 years, 54% female) were included in the analysis. MAC was the preferred anaesthetic modality for conducting ERCP (86% of cases) and was associated with a lower incidence of hypotension (6.1 vs. 18.8%, p = 0.014) and vasopressor use (8.7% vs. 43.8%, p < 0.001). There was no statistically significant difference in the incidence of hypoxia between groups (1.5% vs. 0.0%, p = 0.063). Two cases performed under MAC were complicated by clinically significant aspiration, one requiring conversion to GA.  Variables predicting vasopressor use included age (OR 1.08, p = 0.004), history of ischaemic heart disease (OR 3.33, p = 0.047), general anaesthesia (OR 4.98, p = 0.018), duration of anaesthesia (OR 1.04, p = 0.019) and oral morphine equivalent (1.06, p = 0.031). Intra-operative hypotension was associated with biliary stent exchange (OR 11.47, p = 0.031).

MAC was associated with a lower incidence of hypotension and vasopressor use, but was complicated by aspiration and conversion to general anaesthesia in 1% of cases.  

Keywords: ERCP; monitored anaesthesia care; sedation; general anaesthesia;  hypotension;  hypoxia; adverse events 

There are no declarations of interest.