GA vs conscious sedation in ERCPs

[Guest guest]

I thought that this was a good synopsis of the question from an

authoritative, relevant source. Paragraph two answers my

question concerning the use of GA for some of us (It is the

narcotics issue). And paragraph one can support either the MAC

argument or the GA argument. It seems that you can have GA

with or without endotracheal intubation.....but is that " true " GA or

" near " GA in the precise sense of the word?

http://www.asge.org/nspages/practice/patientcare/deepsedation.

cfm

  

Guidelines for the Use of Deep Sedation and Anesthesia for

Gastrointestinal Endoscopy

In general, most endoscopic procedures are performed under

moderate sedation and analgesia, which is also known as

" conscious sedation. " At this level of sedation, the patient is able

to make a purposeful response to verbal or tactile stimulation,

and both ventilatory and cardiovascular function are maintained.

Patient responsiveness during " deep sedation " involves

purposeful responses to painful stimuli. Airway support may be

required. At the level of general anesthesia, the patient is

unarousable, even to painful stimuli. Airway support is frequently

required and cardiovascular function may be impaired. The

endoscopy team must be able to recognize the various levels of

sedation and analgesia and rescue a patient who exhibits loss

of responsiveness, airway protection, spontaneous respiration

or cardiovascular function.

The level of sedation should be titrated to achieve a safe,

comfortable and technically successful procedure. Different

patients may require different levels of sedation for the same

procedure and patients may attain varying levels of sedation

during a single procedure. The purpose of sedation and

analgesia is to relieve anxiety, discomfort or pain, and diminish

memory for the event. The level of sedation that is adequate to

perform a procedure may range from minimal sedation through

general anesthesia. In general, diagnostic and uncomplicated

therapeutic upper endoscopy and colonoscopy are successfully

performed using moderate (conscious) sedation. Outside of the

United States, endoscopy without sedation has been the

standard in many countries. Deeper levels of sedation may be

considered for longer and more complex procedures, including,

but not limited to, ERCP and EUS. Additionally, patients who

have been or are anticipated to be intolerant of standard

sedatives are also considered for deep sedation or anesthesia.

These patients include chronic users of narcotics and

benzodiazipines, alcoholics, drug addicts and patients with

neuropsychiatric disorders. Routine use of short acting

anesthetics (e.g., propofol) has been advocated by some

authors as a means to improve patient comfort during standard

endoscopic procedures.