Evaluating the Relative Risk of Pulmonary Microaspiration in Sedated Versus Intubated Patients During ERCP Procedures

Abstract

Objectives This study aims to compare the risk of pulmonary microaspiration in patients undergoing ERCP under general anesthesia versus deep sedation.

Study design: Prospective comparative study

Duration and place of study: This study was conducted in Liaquat National Hospital and Medical College Karachi from December 2022 to December 2023

Methodology: One hundred and fifty patients (ASA I-III) undergoing ERCP were selected and randomly distributed in two groups of 75 each: Group I (n= 75) received a general anesthesia (endotracheal intubation) and Group S (n = 75) received deep sedation. All patients were carefully observed in a high-dependency unit (HDU) within 48 hours after the procedure to detect the symptoms of hypoxia. The number of chest CT scans was also taken 48 hours after ERCP to determine if there are new pulmonary infiltrates that indicate microaspiration.

Results: Similarly, evidence of microaspiration on CT was much more severe in the sedation group (24%) than in the intubation group (5.3%), at a p-value of 0.002. Although postoperative hypoxic incidents were seen more frequently in sedation group (26.6%) compared to intubated group (6.6%), the difference was found statistically significant with p-value 0.001. Microaspiration was observed to a greater extent in patients in the sedation group who were between 65 years and more (50%) than in the younger category (6.7%) with a p-value of 0.0008. Other parameters that included incidences of postoperative fever, cough, tachypnea, or obligation to oxygen therapy were alike in the two groups.

Conclusion: The prevalence of postoperative CT alterations that seemed suggestive of microaspiration was increased in sedated patients compared to patients with tracheal intubation who underwent ERCP, especially those aged 65 or more. This notwithstanding, there were no clinical evidences of overt chest infection in any of the groups. These are the findings that advocate that one should be cautious in the selection of patients and close observation in the postoperative period in choosing deep sedation as an option in ERCP.