Sedation for High-Risk ERCPs: Monitored Anesthesia Care or General Anesthesia?

Sedation practices for endoscopic retrograde cholangiopancreatography (ERCP) vary widely in the U.S., but currently, the two most common approaches are monitored aesthesia care (MAC) and general anesthesia (GA). MAC is often faster and less expensive, whereas GA consumes more resources but provides maximal airway access and protection.

These authors randomized 200 patients considered to be at high risk for sedation-related adverse events (SRAE) while undergoing ERCP to receive either MAC or GA. Abdominal ascites, chronic lung disease, and body-mass index ≥35 were among the factors determined to increase risk. The primary outcome was the incidence of composite SRAE, including hypoxemia, need for airway maneuvers, conversion to GA, hypotension…