Comparative risk of pulmonary microaspiration in intubated versus sedated patients undergoing ERCP

Introduction: Endoscopic retrograde cholangio-pancreatography (ERCP) is by far considered the cornerstone in the diagnosis and treatment of biliary and pancreatic diseases. The optimal anesthetic choice for ERCP remains under debate. While general anesthesia offers certain benefits, some drawbacks limit its routine use in ERCP. Monitored anesthesia care (MAC) or deep sedation offers a viable alternative in remote locations, avoiding these drawbacks. Pulmonary aspiration may lead to a serious complication or even death. Potential microasprition during ERCP is an underreported complication and data about it is scarce. We assessed the comparative risk of pulmonary micro aspiration in intubated versus sedated patients undergoing ERCP Methodology: 130 ASA I-III patients were enrolled in the study and divided into two groups: general anesthesia with endotracheal intubation (Group-I) and deep sedation (Group-S). Each group had 65 patients. All patients were monitored for hypoxic episodes in the HDU unit for 48 HRs after ERCP. Also, they were subjected to Computed Tomography (CT) chest after 48 HRs to detect acute pulmonary infiltrates of micro aspiration. Results: The incidence of positive postoperative CT findings for micro aspiration was statistically significantly higher in the Group-S (24.62%) than Group-I (4.62%) with P-value: of 0.002. The incidence of postoperative hypoxic episodes was higher in the Group-S 27.69% versus 6.15% in Group-I but there was no statistically significant difference between both groups. Also, it was found that the incidence of postoperative micro aspiration was statistically significantly higher in patients of ≥ 65 years (52%) than < 65 years (7.5%) of the Group-S with P = 0.014. Incidence of postoperative fever, cough, tachypnea, and the need for O2 supplementation were comparable in both groups. Conclusion: The incidence of positive postoperative CT findings for microaspiration was higher in the sedation group. It was also higher in patients aged ≥ 65 years in the sedation group. Despite these findings, none of the patients developed clear signs of postoperative chest infection. Abbreviations: CT - Computed Tomography; ERCP - Endoscopic retrograde cholangio-pancreatography; ETT- endotracheal intubation; MAC - Monitored anesthesia care Keywords: ERCP, MAC, GA with ETT, pulmonary micro aspiration. Citation: Maher MA, Hassan HF, Refaat AI, Amer MS. Comparative risk of pulmonary microaspiration in intubated versus sedated patients undergoing ERCP. Anaesth. pain intensive care 2024;28(6):1029-1034; DOI:10.35975/apic.v28i6.2611 Received: August 02, 2024; Reviewed: September 06, 2024; Accepted: September 18, 2024