Patients with primary sclerosing cholangitis require more sedation during endoscopic retrograde cholangiography

Abstract

Background and study aims Patients with primary sclerosing cholangitis (PSC) require repeated endoscopic retrograde cholangiography (ERC). Our aim was to evaluate whether patients with PSC require higher doses of sedation during ERC. Patients and methods We retrospectively analyzed all patients undergoing ERC from 2006 to 2013 who received conscious sedation with propofol and midazolam. The duration of the intervention and a potential progression of propofol consumption or intervention time by visit number were analyzed. Univariable and multivariable analyses were performed to identify independent factors which influence propofol consumption. Results A total of 2962 ERC procedures were performed in 1211 patients. Patients with PSC (n = 157) underwent 461 ERC procedures whereas patients without PSC (n = 1054) had 2501 ERC examinations. The total median propofol dose was 450 mg (290 – 630 mg) for patients with PSC and 300 mg (200 – 450 mg) for the non-PSC group (P < 0.05). The propofol consumption in patients with PSC was increased by a factor of 1.24 (P = 0.0071) independent of intervention time. Younger age (< 60.8 years) and duration of the intervention were associated with a higher need for sedation by factors of 1.21 and 1.71, respectively (P < 0.0001). The robustness of the results was tested in a sensitivity analysis which confirmed the results (P < 0.0001). Conclusions Patients with PSC may require higher doses of sedation for ERC compared to other patient groups independent of age and duration of ERC. The higher dosage of sedation has to be taken into account when using ERC to treat a patient with PSC.

Dilatation Therapy and Demographic Characteristics Significantly Influence the Amount of Propofol for Therapeutic Endoscopic Retrograde Cholangiography

“…However, demographic parameters predominate the required amount of sedation. As shown by other studies increase in age and BMI and male gender affect the amount of sedation for endoscopic interventions [9, 11–13]. For example, male patients required 42 mg more propofol than female patients in our model.…”

“…Sedation for ERC is of paramount importance to facilitate complex endoscopic interventions [9]. However, sedation may be associated with severe adverse events and therefore an adequate monitoring and intervention-tailored sedation regimen is necessary [9, 13].…”

“…Increasing evidence suggest that distinct patient groups may require different amounts of sedative drugs for completion of therapeutic ERC independent of gender, weight, and age. In a prior study we could show that patients with primary sclerosing cholangitis (PSC) require more sedative agents for ERC compared to control groups [13]. These findings prompted us to further analyze the efficacy, safety, and factors influencing the required doses of anesthetic drugs in patients undergoing ERC at our institution.…”