Consensus guidelines for the perioperative management of patients undergoing endoscopic retrograde cholangiopancreatography

Azimaraghi, Omid; Bilal, Mohammad; Amornyotin, Somchai; Arain, Mustafa A.; Behrends, Matthias; Berzin, Tyler M.; Buxbaum, James; Choice, Curtis; Faßbender, Philipp; Sawhney, Mandeep S.; Sundar, Eswar; Wongtangman, Karuna; Leslie, Kate; Eikermann, Matthias

doi:10.1016/j.bja.2023.03.012

Cited by 8 publications

(2 citation statements)

References 64 publications

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“…MAC is typically preferred for shorter, routine procedures, while GETA is often used for lengthier, more complex operations. The choice of GETA is most notable in patients with a heightened risk of pulmonary aspiration [ 9 ]. Concerningly, the risks of hypotension and reduced cardiac output are higher with GETA compared to MAC, making the prone position an added layer of consideration.…”

Section: Discussionmentioning

confidence: 99%

“…Concerningly, the risks of hypotension and reduced cardiac output are higher with GETA compared to MAC, making the prone position an added layer of consideration. This is evidenced by a comprehensive observational study, which demonstrated that hypotension occurred in 59% of patients who underwent general anesthesia for ERCP, compared with only 14% of those who received monitored anesthesia care [9][10][11][12].…”

Section: Management Recommendationsmentioning

confidence: 99%

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Understanding the Physiological Connection: Cardiac Arrest Following Prone Positioning

Dhoon,

Tiwari,

Villaluz

et al. 2024

Cureus

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Prone positioning of patients is a routine occurrence in procedural suites and operating rooms (ORs). However, the physiological changes that occur with prone positioning are frequently underappreciated by proceduralists, surgeons, and anesthesiologists. This may be related to a sense of the routine or a lack of familiarity with physiological changes that accompany the prone position. The prone position, while aiding visualization and cannulation of the ampulla of Vater during endoscopic retrograde cholangiopancreatography (ERCP), can induce physiological changes such as reduced preload, inferior vena cava filling, and cardiac output; it can also increase intrathoracic pressure and mediastinal compression. Anesthetic agents can further impact cardiopulmonary physiology, decreasing systemic vascular resistance and reducing cardiac contractility. In addition, the transition from negative to positive pressure ventilation following endotracheal intubation can increase pulmonary artery pressures and right ventricular (RV) strain. Therefore, caution is needed with patients who have RV dysfunction, pulmonary hypertension, or preload dependency, as they may not tolerate prone positioning. We describe a case in which a 73-year-old male patient scheduled for an ERCP suffered cardiac arrest after being transitioned to the prone position. The patient was repositioned in the supine position and resuscitated. The case was completed in the supine position.

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Section: Discussionmentioning

confidence: 99%