Anesthetic Challenges and Safety Profile in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography

Abstract

Background: Endoscopic Retrograde Cholangiopancreatography (ERCP) is a technically demanding procedure requiring optimal sedation and vigilant anesthetic management, especially in patients with comorbidities. The aim of this study was to assess anesthetic challenges and safety outcomes associated with ERCP under Total Intravenous Anesthesia (TIVA).

Methods: This retrospective observational study was conducted over 12 months from January to December 2024 at Popular Diagnostic Centre Ltd and Popular Medical College Hospital, Dhaka, Bangladesh. A total of 340 patients aged 20–79 years who underwent ERCP under monitored anesthesia care were included. Data on demographics, comorbidities, procedure type, anesthetic drugs and intra-procedural complications were analyzed using SPSS version 25.

Results: The mean age of the study population was 60 ± 8.4 years, with a female predominance (70.29%). Common comorbidities included hypertension (30.29%), diabetes mellitus (20.29%), bronchial asthma (15.29%) and liver disease (10.29%). All procedures were conducted using TIVA with propofol, midazolam, fentanyl and ketamine. The average duration was 36.2 ± 6.9 minutes. Plastic stent placement and pancreatic procedures were each performed in 14.71% of cases, while metal stents were used in 6.18%. Anesthetic complications included desaturation (20%), hypotension (4.12%), airway obstruction (2.94%) and one procedure-related death (0.29%). Most adverse events were managed conservatively without conversion to general anesthesia.

Conclusion: ERCP under TIVA is generally safe when conducted with experienced personnel and vigilant monitoring. However, a proactive approach to managing respiratory and hemodynamic complications is essential to optimize outcomes.