ABSTRACT
Objective To compare the sedative efficacy and safety of dexmedetomidine and sufen-tanil combined with propofol in elderly patients undergoing endoscopic retrograde cholangiopancreatography(ERCP).Methods Sixty elderly patients from July to October 2022,aged 65-90 years,BMI 15-33 kg/m2,ASA physical status Ⅰ-Ⅲ,had normal cardiac function or NHYA grade Ⅰ or Ⅱ,underwent ERCP were enrolled.Patients were divided into two groups by random number table method:the dexmedeto-midine group(group D)and the sufentanil group(group S),30 patients in each group.Group D received an intravenous infusion of dexmedetomidine 0.5 μg/kg for 10 minutes followed by intravenous propofol 1 mg/kg for sedation induction.Group S received intravenous sufentanil 0.12 μg/kg followed by intravenous propofol 1 mg/kg for sedation induction.The operation time,total dosage of propofol,incidence of body movement were recorded.The lowest SpO2,use of airway interventions,incidence of hypoxemia were recor-ded.Adverse cardiovascular events(tachycardia,bradycardia,hypertension,hypotension,and arrhythmia)were recorded.Awakening time,VAS pain scores at rest 15 minutes after entering PACU,incidence of mod-erate to severe postoperative pain,and postoperative nausea and vomiting in PACU were recorded.Results Adequate deep sedation was successfully achieved in the two groups(Ramsay scale≥5 scores).Compared with group S,the lowest SpO2 and bradycardia were significantly increased(P＜0.05),the use of airway interventions,hypoxemia,tachycardia,and hypotension were significantly decreased in group D(P＜0.05).There were no significant differences in operation time,total dosage of propofol,incidence of body movement,hypertension,VAS pain scores at rest 15 minutes after entering PACU,moderate to severe post-operative pain,and postoperative nausea and vomiting in PACU between the two groups.Conclusion Dexmedetomidine or sufentanil combined with propofol can provide adequate deep sedation for ERCP proce-dure.Dexmedetomidine combined with propofol can keep intraoperative cardiovascular function more stable,and reduce the occurrence of intraoperative hypoxemia and cardiovascular adverse events.
ABSTRACT
Objective:To investigate the influencing factors for endoscopic retrograde cholangiopancreatography (ERCP)-related adverse events in novice trainees and establishment of its prediction model.Methods:The prospective study was conducted. The clinical data of 12 novice trainees of ERCP in the First Hospital of Lanzhou University from July 2016 to July 2019 were selected. The operation was performed by 12 novice trainees of ERCP under the guidance of the endoscopic experts. Observation indicators: (1) ERCP-related adverse events in novice trainees; (2) analysis of influencing factors for ERCP-related adverse events in novice trainees; (3) establishment of a prediction model for ERCP-related adverse events in novice trainees. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed by the t test. Measurement data with skewed distribution were represented as M(range), and com-parison between groups was analyzed by the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed by the chi-square test. The Logistic regression model was used for univariate and multivariate analyses. The regression coefficients were used to construct a prediction model. The receiver operating characteristic curve was drawn, and the area under curve was used to evaluate the predictive ability. Results:(1) ERCP-related adverse events in novice trainees. Of the 300 patients with ERCP operated by 12 novice trainees, 52 cases had ERCP-related adverse events and 248 cases had no ERCP-related adverse events. Cases in grade 1?2 or grade 3?4 of ERCP difficulty classification, score for intubation time, score for cannulation time, cases with or without completion of the cannulation, cases with or with-out basket stone removal, cases with or without stenosis expansion, score for contrast-enhanced interpretation, score for implementation of reasonable treatment and score for expected purpose reached were 22, 30, 8(range, 5?10), 20(rang, 9?20), 24, 28, 11, 41, 0, 52, 39±17, 39±19 and 44±23 for novice trainees with ERCP-related adverse events, versus 146, 102, 6(range, 4?9), 12(range, 8?20), 163, 85, 94, 154, 20, 228, 52±22, 80±20, 52±23 for novice trainees without ERCP-related adverse events, showing significant differences in the above indicators between them ( χ2=4.79, Z=?2.46, ?2.72, χ2=7.01, 5.30, 4.49, t=?4.00, ?2.97, ?2.29, P<0.05). (2) Analysis of influencing factors for ERCP-related adverse events in novice trainees. Results of univariate analysis showed that the diffi-culty classification of ERCP, intubation time, cannulation time, completion of cannulation, basket stone extraction, contrast-enhanced interpretation, implementation of reasonable treatment and expected purpose reached were related factors for ERCP-related adverse events in novice trainees ( odds ratio=1.95, 1.11, 1.08, 0.45, 0.44, 0.97, 0.98, 0.98, 95% confidence intervals as 1.07?3.58, 1.02?1.22, 1.02?1.14, 0.24?0.82, 0.22?0.90, 0.96?0.99, 0.96?0.99, 0.97?1.00, P<0.05). Results of multi-variate analysis showed that difficulty classification of ERCP and contrast-enhanced interpretation were independent influencing factors for ERCP-related adverse events in novice trainees ( odds ratio=2.08, 0.95, 95% confidence intervals as 1.10?3.96, 0.92?0.99, P<0.05). (3) Establishment of a predic-tion model for ERCP-related adverse events in novice trainees. According to the important outcome indicators of clinical training and results of multivariate analysis, 4 indicators including difficulty classification of ERCP, intubation time, cannulation time and contrast-enhanced interpretation were included to establish a prediction model for ERCP-related adverse events in novice trainees, which indicated that trainees with the predicted score >0.4 were in high risk of ERCP-related adverse events. The area under receiver operating characteristic curve of the prediction model was 0.72(95% confidence interval as 0.65?0.79, P<0.05), with the best cut-off value as 0.40, the sensitivity as 76.9% and the specificity as 63.3%. Conclusion:The difficulty classification of ERCP and contrast-enhanced interpretation are independent influencing factors for ERCP-related adverse events in novice trainees. Novice trainees with a predicted score >0.4 are high-risk groups of ERCP-related adverse events.
ABSTRACT
Introducción: las variantes anatómicas de las vías biliares son frecuentes, por eso su conocimiento es de suma importancia durante la realización de procedimientos quirúrgicos de las vías biliares como la colecistectomía laparoscópica, con la finalidad de evitar lesiones incidentales de las mismas; en el presente estudio, se deter-minaron éstas variantes por colangiografía retrógrada endoscópica (CPRE), así como también su asociación con enfermedades de las vías biliares. Pacientes y métodos: Se evaluaron todos los pacientes que acudieron al Servicio de Gastroenterología del Hospital Universitario de Caracas, con indicación de realización de CPRE y se incluyeron 232 sujetos divididos en dos grupos, uno conformado por sujetos con presencia de variantes anatómicas de las vías biliares y el otro por sujetos sin varian-tes anatómicas de las vías biliares, luego se relacionaron ambos grupos con las en-fermedades coexistentes. Resultados: Se encontraron 168 casos con variantes del cístico, que corresponde a 72,4%, y 56 casos con variantes anatómicas de las vías biliares intrahepáticas, correspondiente a 24,1%. La variante anatómica del cístico más común correspondió a la inserción posterior (n= 32; 19,1%), encontrándose combinaciones con otras variantes del cístico (espiral posterior en 5 casos, posterior alta en 1 caso, posterior baja en 1 caso y espiral posterior baja en 1 caso). La segun-da variante del cístico más frecuente fue la inserción baja (n = 18; 10,7%). La variante anatómica de las vías biliares intrahepáticas más común fue la tipo B (n= 25; 44,6%), seguida de la tipo C1 (n= 18; 32,1%). La coledocolitiasis fue el diagnóstico más frecuente tanto en los pacientes con variantes anatómicas, como en los sin variantes anatómicas, correspondiendo respectivamente a 33,3% vs 34,8%; p = 0,40. De los pacientes con coledocolitiasis, la variante anatómica del cístico más frecuente fue la inserción posterior (17,5%). Conclusiones: Las variantes anatómicas de las vías biliares son frecuentes. La variante anatómica del cístico más frecuente fue la inserción posterior, mientras que variante anatómica de vías biliares la intrahepáticas fue la tipo B. La patología más frecuente, tanto en pacientes con variante anatómica como los pacientes sin variante anatómica, fue la coledocolitiasis. Sin embargo, no se encontró asociación entre las variantes anatómicas de las vías biliares y las enfermedades biliares.
Introduction: anatomic variants of the biliary tract are frequent, so his knowledge is of utmost importance for performing surgical procedures of the bile ducts as laparo-scopic cholecystectomy to prevent incidental injury of the biliar tree; in this study these variants were determined by retrograde cholangiopancreatography (ERCP) and its relationship with diseases of the biliary tract. Patient and Method: All patients who attended in the Gastroenterology Service of the University Hospital of Caracas with indicating ERCP, were evaluated, and 232 subjects were included, divided into two groups, one composed of subjects with presence of anatomic variants of the biliary tract, another for patients without anatomic variants of the biliary tract, then both groups coexisting illnesses related. Results: 168 cases with cystic duct variants, corresponding to 72.4%, and 56 cases with anatomical variations of intrahepatic bile ducts, corresponding to 24.1% were found. The most common anatomic variant cystic duct corresponded to the posterior insertion (n = 32; 19.1%), finding combinations with other variants of the cystic duct (posterior/spiral in 5 cases, posterior/high in 1 case, 1 case posterior/low and posterior/low/spiral in 1 case). The second variant more common was low insertion (n = 18; 10.7%). Most common variant of intrahepatic bile duct was the type B (n= 25; 44.6%), followed by type C1 (n= 18; 32.1%). Choledocholithiasis was the most frequent diagnosis in both patients with anatomical variants, as in no anatomical variants, corresponding respectively to 33.3% vs 34.8%; p= 0.40. Of patients with choledocholithiasis, the more common anatomical variant of cystic duct was low insertion (17.5%). Conclusions: The anatomic variants of the biliary tract are common. The more common anatomical variant of cystic duct was low insertion, while anatomical variant of the intrahepatic bile ducts was the type B. The most common pathology, both in patients with anatomical variant and in patients without anatomic variant, was choledocholithiasis. However, no association between the anatomic variants of the biliary tract and biliary diseases was found.