How patient-controlled sedation is adopted in clinical practice of sedation for endoscopic retrograde cholangiopancreatography? A prospective study of 1196 cases

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Jokelainen , J , Udd , M , Kylänpää , L , Mustonen , H , Halttunen , J , Lindstrom , O & Pöyhiä , R 2017 , ' How patient-controlled sedation is adopted in clinical practice of sedation for endoscopic retrograde cholangiopancreatography? A prospective study of 1196 cases ' , Scandinavian Journal of Gastroenterology , vol. 52 , no. 2 , pp. 166-172 . https://doi.org/10.1080/00365521.2016.1242024

Title: How patient-controlled sedation is adopted in clinical practice of sedation for endoscopic retrograde cholangiopancreatography? A prospective study of 1196 cases
Author: Jokelainen, Jarno; Udd, Marianne; Kylänpää, Leena; Mustonen, Harri; Halttunen, Jorma; Lindstrom, Outi; Pöyhiä, Reino
Other contributor: University of Helsinki, Clinicum
University of Helsinki, Department of Surgery
University of Helsinki, Clinicum
University of Helsinki, II kirurgian klinikka
University of Helsinki, II kirurgian klinikka
University of Helsinki, Clinicum






Date: 2017
Language: eng
Number of pages: 7
Belongs to series: Scandinavian Journal of Gastroenterology
ISSN: 0036-5521
DOI: https://doi.org/10.1080/00365521.2016.1242024
URI: http://hdl.handle.net/10138/311384
Abstract: Objective: Patient-controlled sedation (PCS) has been shown to be a valid choice for sedation during endoscopic retrograde cholangiopancreatography (ERCP) in randomized studies. However, large-scale studies are lacking. Material and methods: A single center, prospective observational study to determine how sedation for ERCP is administered in clinical setting. All 956 patients undergoing 1196 ERCPs in the endoscopy unit of Helsinki University Central Hospital 2012-2013, methods of sedation and adverse events associated with different sedations were recorded. Results: PCS was attempted a total of 685 times (57%), successful use of PCS was achieved with 526 patients (77% of attempts). PCS device was operated by the anesthesiologist or anesthesia nurse 268 times (22%). PCS was more likely chosen for younger (80.6% for <=60 years vs. 63.8% for >60 years, p <.001) patients and by trainee anesthetists. Anesthesiologist administered propofol sedation was used 240 times (20%). The risk of failure of PCS was increased, if systolic arterial pressure was <90mmHg, dosage of PCS > 17 ml, duration of procedure exceeded 23 min. The risk of failure was lower in patients with primary sclerosing cholangitis (PSC) and if sedation was deeper RASS<= -2. Uneventful PCS was associated with less respiratory and cardiovascular depression than other methods. There were no statistically significant differences in safety profiles with all the methods of sedation. Conclusions: PCS is readily implemented in clinical practice, is suitable for younger and low-risk patients and is associated with less cardiorespiratory adverse effects.
Subject: Endoscopic retrograde cholangiopancreatography
patient-controlled sedation
sedation
ADMINISTERED PROPOFOL SEDATION
ELDERLY-PATIENTS
CONTROLLED-TRIAL
PRIMARY-CARE
ERCP
IMPLEMENTATION
REMIFENTANIL
COLONOSCOPY
MANAGEMENT
ATTITUDES
3126 Surgery, anesthesiology, intensive care, radiology
3121 General medicine, internal medicine and other clinical medicine
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