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Safety of the LMA®Gastro™ for Endoscopic Retrograde Cholangiopancreatography
- Source :
- Anesthesia & Analgesia. 131:1566-1572
- Publication Year :
- 2020
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2020.
-
Abstract
- Background Endoscopic retrograde cholangiopancreatography (ERCP) patients typically receive either tubeless anesthesia or general endotracheal anesthesia (GETA). Patients receiving propofol-based total intravenous anesthesia (TIVA) are at higher risk of sedation-related adverse events (SRAEs) than patients receiving GETA, primarily due to the need for additional airway maneuvers. The increasing use of non-operating room (OR) anesthesia and the perception of a higher incidence of adverse outcomes in non-OR areas has led to the development of devices to improve safety while maintaining efficiency. The purpose of this study was to evaluate if the LMA Gastro™ could be used as a safe alternative to tubeless anesthesia for successfully completing ERCPs. Methods Eligible subjects were identified within the patient population at MD Anderson Cancer Center. Inclusion criteria consisted of adult patients (≥18 years old) scheduled for elective ERCP with TIVA. This was a prospective observational study in which the following data were collected: number of attempts and time to successful supraglottic airway (SGA) placement, vital signs, peripheral oxygen saturation (SpO2), median end-tidal CO2, practitioner satisfaction, and any complications. Results A total of 30 patients were included in this study. The overall rate of successful SGA placement within 3 attempts was 96.7% (95% confidence interval [CI], 82.8-99.9) or 29/30. The rate of successful ERCP with SGA placement within 3 attempts was 93.3% (95% CI, 77.9-99.2) or 28/30. Both the gastroenterologist and anesthesiologist reported satisfaction with the device in 90% of the cases (in 66.7% of the cases both anesthesiologist and gastroenterologist scored the device a 7/7 for satisfaction). Patients maintained an SpO2 of 95%-100% from induction to discharge, with the exception of 1 patient who had an SpO2 of 93%. The median end-tidal CO2 during the procedure for all patients was 35 mm Hg. Observed aspiration did not occur in any patient. Symptoms of hoarseness (13.3%), mouth soreness (6.7%), sore throat (6.6%), and minor bleeding/cuts/redness/change in taste to the tongue (3.3%) were determined through patient questioning before postanesthesia care unit (PACU) discharge. Conclusions Our study suggests that the LMA Gastro might be a safe alternative for ERCP procedures. There was a high level of practitioner satisfaction. Only minor complications, such as hoarseness, mouth or throat soreness, or minor trauma to the tongue were experienced by patients. Similar incidences of complications may occur with GETA and tubeless anesthesia. The procedure was well tolerated by all patients; all patients maintained adequate oxygenation and required only minimal blood pressure support.
- Subjects :
- Adult
Male
Vital signs
Laryngeal Masks
Pacu
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Tongue
030202 anesthesiology
Gastro
medicine
Sore throat
Humans
Prospective Studies
Airway Management
Adverse effect
Aged
Aged, 80 and over
Cholangiopancreatography, Endoscopic Retrograde
Hoarseness
Endoscopic retrograde cholangiopancreatography
medicine.diagnostic_test
biology
business.industry
Gastroenterologists
Pharyngitis
Carbon Dioxide
Middle Aged
biology.organism_classification
Anesthesiologists
Oxygen
Anesthesiology and Pain Medicine
Anesthesia
Female
Patient Safety
medicine.symptom
Propofol
Airway
business
030217 neurology & neurosurgery
medicine.drug
Subjects
Details
- ISSN :
- 00032999
- Volume :
- 131
- Database :
- OpenAIRE
- Journal :
- Anesthesia & Analgesia
- Accession number :
- edsair.doi.dedup.....55bc2a7c6d4eeaf61b2f8e0617aead94