切换至 "中华医学电子期刊资源库"

中华胃肠内镜电子杂志 ›› 2025, Vol. 12 ›› Issue (02) : 74 -85. doi: 10.3877/cma.j.issn.2095-7157.2025.02.002

共识与解读

ERCP 麻醉管理专家共识(2025 年,北京)
中华医学会消化内镜学分会1, 中国老年医学学会麻醉学分会2   
  1. 1. 100700 北京,中华医学会消化内镜学分会
    2. 100055 北京,中国老年医学学会麻醉学分会
  • 收稿日期:2025-04-25 出版日期:2025-05-15
  • 基金资助:
    国家重点研发计划(2022YFC2503600)

Expert consensus on anesthesia management of ERCP (2025, Beijing)

Society of Digestive Endoscopology Chinese, Geriatric Medicine Society of Anesthesiology Chinese   

  • Received:2025-04-25 Published:2025-05-15
引用本文:

中华医学会消化内镜学分会, 中国老年医学学会麻醉学分会. ERCP 麻醉管理专家共识(2025 年,北京)[J/OL]. 中华胃肠内镜电子杂志, 2025, 12(02): 74-85.

Society of Digestive Endoscopology Chinese, Geriatric Medicine Society of Anesthesiology Chinese. Expert consensus on anesthesia management of ERCP (2025, Beijing)[J/OL]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2025, 12(02): 74-85.

表1 推荐强度分级和循证证据等级
表2 ERCP 操作特点及难度分级
表3 Ramsay 镇静评分
表4 改良Aldrete 评分标准
附录1 中英文缩略词表
[1]
令狐恩强.消化内镜学名词[M].北京:科学出版社,2021.
[2]
中华医学会消化内镜学分会ERCP 学组,中国医师协会消化医师分会胆胰学组,国家消化系统疾病临床医学研究中心.中国ERCP 指南(2018 版)[J]. 中华消化内镜杂志,2018,35(11):777-813.
[3]
李汛.中国外科ERCP 医师培训专家共识意见(2022 版)[J].中华消化内镜杂志,2022,39(6):421-429.
[4]
Barton TH,Petersen BT,Mergener K,et al.Quality Indicators for endoscopic retrograde cholangiopancreatography [ J]. Am J Gastroenterol,2006,101:892-897.
[5]
Adler DG,Lieb JG,Cohen J,et al. Quality indicators for ERCP[J].Gastrointest Endosc,2015,81(1):54-66.
[6]
Howell SJ,Absalom AR. Consensus guideline,Delphi methods,and evidence around anaesthetic technique for endoscopic retrograde cholanglopancreatography[J].Br J Anaesth,2023,131(4):634-636.
[7]
Guyatt GH,Oxman AD,Vist GE,et al. GRADE:an emerging consensus on rating quality of evidence and strength of recommendations[J].BMJ,2008,336:924-926.
[8]
Sharma VK,Nguyen CC,Crowell MD,et al. A national study of cardiopulmonary unplanned events after GI endoscopy [J].Gastrointest Endosc,2007,66(1):27-34.
[9]
Enestvedt BK,Eisen GM,Holub J,et al. Is the American Society of Anesthesiologists classification useful in risk stratification for edoscopicprocedures? [J]. Gastrointest Endosc,2013,77(3):464-471.
[10]
ASGE Standards of Practice Committee,Acosta RD,Abraham NS,et al. The management of antithrombotic agents for patients undergoing GI endoscopy[J].Gastrointest Endosc,2016,83(1):3-16.
[11]
Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures:An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration[J].Anesthesiology,2017,126(3):376-393.
[12]
Green SM, Leroy PL, Roback MG, et al. An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children[J]. Anesthesia,2020,75:374-385.
[13]
Thompson BF,Arguedas MR,Wilcox CM. Antibiotic prophylaxis prior to endoscopic retrograde cholangiopancreatography in patients with obstructive jaundice:is it worth the cost? [J].Aliment Pharmacol Ther,2002,16(4):727-34.
[14]
Ramsay MA,Savege TM,Simpson BR,et al. Controlled sedation with alphaxalone-alphadolone[J]. Br Med J,1974,2(5920):656-659.
[15]
Azimaraghi O,Bilal M,Amornyotin S,et al.Consensus guidelines for the perioperative management of patients undergoing endoscopic retrograde cholangiopancreatography [ J]. Br J Anaesth,2023,130(6):763-772.
[16]
Ong WC,Santosh D,Lakhtakia S,et al. A randomized controlled trial on use of propofol alone versus propofol with midazolam,ketamine, and pentazocine “ sedato-analgesic cocktail” for sedation during ERCP[J].Endoscopy,2007,39(9):807-812.
[17]
Goyal R,Hasnain S,Mittal S,et al.A randomized,controlled trial to compare the efficacy and safety profile of a dexmedetomidineketamine combination with a propofol-fentanyl combination for ERCP[J].Gastrointest Endosc,2016,83(5):928-933.
[18]
Dong SA,Guo Y,Liu SS,et al. A randomized,controlled clinical trial comparing remimazolam to propofol when combined with alfentanil for sedation during ERCP procedures [J]. J Clin Anesth,2023,86:111077.
[19]
Mazanikov M, Udd M, Kylanpaa L, et al. Patient-controlled sedation with propofol and remifentanil for ERCP:a randomized,controlled study[J]. Gastrointest Endosc,2011,73(2):260-266.
[20]
Gan TJ,Belani KG,Bergese S,et al.Fourth consensus guidelines for the management of postoperative nausea and vomiting[J].Anesth Analg,2020,131(2):411-448.
[21]
Gotoda T,Akamatsu T,Abe S,et al. Guidelines for sedation in gastroenterological endoscopy (second edition)[J].Dig Endosc,2021,33(1):21-53.
[22]
Qadeer MA,Vargo JJ,Dumot JA,et al.Capnographic monitoring of respiratory activity improves safety of sedation for endoscopic cholangiopancreatography and ultrasonography[J].Gastroenterology,2009,136(5):1568-76,quiz1819-1820.
[23]
Gotoda T,Okada H,Hori K,et al.Propofol sedation with a targetcontrolled infusion pump and bispectral index monitoring system in elderly patients during a complex upper endoscopy procedure[J].Gastrointest Endosc,2016,83(4):756-764.
[24]
Cotton PB, Garrow DA, Gallagher J, et al. Risk factors for complications after ERCP: a multivariate analysis of 11497 procedures over 12 years[J].Gastrointest Endosc,2009,70(1):80-88.
[25]
Thiruvenkatarajan V,Sekhar V,Wong DT,et al. Effect of highflow nasal oxygen on hypoxaemia during procedural? sedation:a systematic review and meta-analysis[J]. Anaesthesia,2023,78(1):81-92.
[26]
Lee CC,Ju TR,Lai PC,et al. Should we use High-Flow Nasal Cannula in patients receiving gastrointestinal endoscopies?critical appraisals through updated Meta-Analyses with multiple methodologies and depiction of certainty of evidence[J]. J Clin Med,2022,11(13):3860.
[27]
Soni N,Williams P.Positive pressure ventilation: what is the real cost? [J].Br J Anaesth,2008,101:446-457.
[28]
Pinsky MR.Cardiovascular issues in respiratory care[J]. Chest,2005,128:592S-597S.
[29]
Wachtendorf LJ, Azimaraghi O, Santer P, et al. Association between intraoperative arterial hypotension and postoperative delirium after noncardiac surgery: a retrospective multicenter cohort study[J].Anesth Analg,2022,134(4):822-833.
[30]
Whalin MK, Halenda KM, Haussen DC, et al. Even small decreases in blood pressure during conscious sedation affect clinical outcome after stroke thrombectomy: an analysis of hemodynamic thresholds[J]. Am J Neuroradiol,2017,38(2):294-298.
[31]
Sudheer PS,Logan SW,Ateleanu B,et al. Haemodynamic effects of the prone position:a comparison of propofol total intravenous and inhalation anaesthesia[J]. Anaesthesia,2006,61(2):138-141.
[32]
Terruzzi V,Radaelli F,Meucci G,et al. Is the supine position as safe and effective as the prone position for endoscopic retrograde cholangiopancreatography? A prospective randomized study[J].Endoscopy,2005,37(12):1211-1214.
[33]
Smith ZL,Mullady DK,Lang GD,et al. A randomized controlled trial evaluating general endotracheal anesthesia versus monitored anesthesia care and the incidence of sedation-related adverse events during ERCP in high-risk patients [J]. Gastrointest Endosc,2019,89(4):855-862.
[34]
Althoff FC, Agnihotri A, Grabitz SD, et al. Outcomes after endoscopic retrograde cholangiopancreatography with general anaesthesia versus sedation[J]. Br J Anaesth,2021,126(1):191-200.
[35]
Newman DH,Azer MM,Pitetti RD,et al. When is a patient safe for discharge after procedural sedation? The timing of adverse effect events in 1367 pediatric procedural sedations[J]. Ann Emerg Med,2003,42(5):627-635.
[36]
Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia,the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association,American Society of Dentist Anesthesiologists,and Society of Interventional Radiology[J].Anesthesiology,2018,128(3):437-479.
[37]
Dumonceau JM,Andriulli A,Elmunzer BJ,et al. Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy ( ESGE ) Guideline-updated June 2014 [ J].Endoscopy,2014,46(9):799-815.
[38]
Kochar B,Akshintala VS,Afghani E,et al. Incidence,severity,and mortality of post-ERCP pancreatitis:a systematic review by using randomized, controlled trials[J]. Gastrointest Endosc,2015,81(1):143-149.
[39]
Aldrete JA,Kroulik DA.postanesthetic recovery score[J].Anesth Analg,1970,49(6):924-934.
[40]
Travis AC,Pievsky D,Saltzman JR.Endoscopy in the elderly[J].Am J Gastroenterol,2012,107(10):1494-1502.
[41]
Niehaus M, Tebbenjohanns J. Electromagnetic interference in patients with implanted pacemakers or cardioverter-defibrillators[J].Heart,2001,86(3):246-248.
[42]
中华医学会麻醉学分会老年人麻醉与围术期管理学组,国家老年疾病临床医学研究中心,国家老年麻醉联盟. 中国老年患者围手术期麻醉管理指导意见(2020 版)(一)[J].中华医学杂志,2020,100(31):2404-2415.
[43]
王薇,王昌理,薄禄龙,等. 《改善围手术期脑健康:围手术期管理团队关键行动的专家共识》解读[J].国际麻醉学与复苏杂志,2021,42(9):897-900.
[44]
Early YDS,Lightdale JR,Vargo JJ,et al. Guidelines for sedation and anesthesia in GI endoscopy[J]. Gastrointest Endosc,2018,87(2):327-337.
[45]
Tsai TJ,Chan HH,Lai KH,et al. Gallbladder function predicts subsequent biliary complications in patients with common bile duct stones after endoscopic treatment? [J].BMC Gastroenterol,2018,18(1):32.
[46]
Liang CM,Kuo CM,Lu LS,et al. A comparison between nonsedation and general endotracheal anesthesia for retrograde endoscopic common bile duct stone removal:A tertiary center experience[J].Biomed J,2019,42(2):131-136.
[47]
Behrens A, Kreuzmayr A, Manner H, et al. Acute sedationassociated complications in GI endoscopy (ProSed 2 Study):results from the prospective multicentre electronic registry of sedation-associated complications[J].Gut,2019,68(3):445-452.
[48]
Godoroja-Diarto D,Constantin A,Moldovan C,et al.Efficacy and Safety of Deep Sedation and Anaesthesia for Complex Endoscopic Procedures-A Narrative Review[J]. Diagnostics(Basel),2022,12(7):1523.
[49]
张鹏鹏.右美托咪定复合丙泊酚用于高龄患者ERCP 术中的麻醉效果观察[J].甘肃医药,2019,38(1):34-35,56.
[50]
Berzin TM,Sanaka S,Barnett SR,et al.A prospective assessment of sedation-related adverse events and patient and endoscopist satisfaction in ERCP with anesthesiologist-administered sedation[J].Gastrointest Endosc,2011,73(4):710-717.
[51]
李悦,朱康丽,武晓丽.经内镜逆行胰胆管造影术镇静/麻醉的临床研究进展[J].中华消化内镜杂志,2020,37(1):63-66.
[52]
郭曲练,程智刚,胡浩.麻醉后监测治疗专家共识[J].临床麻醉学杂志,2021,37(1):89-94.
[53]
Belcher AW,Leung S,Cohen B,et al.Incidence of complications in the post-anesthesia care unit and associated healthcare utilization in patients undergoing non-cardiac surgery requiring neuromuscular blockade 2005-2013:A single center study[J]. J Clin Anesth,2017,43:33-38.
[54]
Day LW,Lin L,Somsouk M. Adverse events in older patients undergoing ERCP:a systematic review and meta-analysis[J].Endosc Int Open,2014,2(1):E28-E36.
[55]
Zhang DY,Zhai YQ,Zhang GJ,et al. Safety and efficacy of therapeutic endoscopic retrograde cholangiopancreatography for patients over 90 years of age[J]. Geriatr Gerontol Int,2022,22(1):50-55.
[56]
Iqbal U,Anwar H, Khan MA, et al. Safety and Efficacy of EndoscopicRetrogradeCholangiopancreatographyin Nonagenarians:A Systematic Review and Meta-Analysis[J]. Dig Dis Sci,2022,67(4):1352-1361.
[57]
邓朝晖,蒋丽蓉,许春娣.小儿经内镜逆行胰胆管造影术的临床应用[J].临床儿科杂志,2008,26(4):359-361.
[58]
Dumonceau JM, Garcia-Fernandez FJ, Verdun FR, et al.Radiation protection in digestive endoscopy:European Society of Digestive Endoscopy (ESGE) Guideline[J]. Endoscopy,2012,44(4):408-421.
[59]
Giefer MJ,KozarekRA. Technical outcomes and complications of pediatric ERCP[J].Surg Endosc,2015,29(12):3543-3550.
[60]
赵哲,缪怡.儿童无痛消化内镜诊疗的麻醉管理[J]. 中国实用儿科杂志,2022,37(12):919-924.
[61]
中国消化内镜诊疗镇静/麻醉操作技术规范[J].临床麻醉学杂志,2019,35(1):81-84.
[62]
张海英.不同麻醉方法行小儿胃镜检查术对儿童心理的影响[J].安徽医药,2007,11 (4):362.
[63]
郭城,张琳.无痛消化内镜在儿童消化道疾病诊治中的优势[J].中国实用儿科杂志,2018,33(11):825-828.
[64]
Ian S,Peter K,Isabelle M,et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology[J].Eur J Anaesthesiol,2011,28(8):556-569.
[65]
Frykholm P,Schindler E,Sümpelmann R,et al. Preoperative fasting in children: review of existing guidelines and recent developments[J].Br J Anaesth,2018,120(3):469-474.
[66]
Issa H,Al-HaddadA,Al-Salem AH. Diagnostic and therapeutic ERCP in the pediatric age group[J]. Pediatr Surg Int,2007,23(2):111-116.
[67]
Jang JY, Yoon CH, Kim KM. Endoscopic retrograde cholangiopancreatography in pancreatic and biliary tract disease in Korean children[J].World J Gastroenterol,2010,16(4):490-495.
[68]
Lauren H,Kevin H,Peter D,et al. The safety and efficacy of therapeutic ERCP in the pediatric population performed by adult gastroenterologists[J]. Dig Dis Sci,2013,58(12):3611-3619.
[69]
万兴丽,苏绍玉,唐军等.早产儿出生后黄金小时体温集束化管理对入院体温及临床结局的影响[J].中国当代儿科杂志,2018,20(8):613-617.
[70]
刘小颖,吴新民.围术期低体温[J]. 中华麻醉学杂志,2003,23(9):72-74.
[71]
Qadeer MA, Rocio LA, Dumot JA, et al. Risk factors for hypoxemia during ambulatory gastrointestinal endoscopy in ASA III patients[J].Dig Dis Sci,2009,54(5):1035-1040.
[72]
Dhariwal A,Plevris JN,Lo NT,et al. Age,anemia,and obesityassociated oxygen desaturation during upper gastrointestinal endoscopy[J].Gastrointest Endosc,1992,38(6):684-688.
[73]
Goudra BG,Singh PM,Penugonda LC,et al.Significantly reduced hypoxemic events in morbidly obese patients undergoing gastrointestinalendoscopy:Predictors and practice effect[J]. J Anaesthesiol Clin Pharmacol,2014,30(1):71-77.
[74]
Chiang JK,Lin YC,Lu CM,et al. Snoring Index and Neck Circumference as Predictors of Adult Obstructive Sleep Apnea[J].Healthcare(Basel),2022,10(12):1-9.
[75]
Li N,Wu J,Lu Y,et al.Predictive value of NoSAS questionnaire combined with the modified Mallampati grade for hypoxemia during routine sedation for gastrointestinal endoscopy[J]. BMC Anesthesiol,2023,23(1):126.
[76]
Nightingale CE,Margarson MP,Shearer E,et al. Peri-operative management of the obese surgical patient 2015:Association of Anaesthetists of Great Britain and Ireland Society for Obesity and Bariatric Anaesthesia[J].Anaesthesia,2015,70(7):859-876.
[77]
Vargo JJ.Sedation in the bariatric patient[J].Gastrointest Endosc Clin N Am,2011,21(2):257-263.
[78]
Shao LJ,Liu SH,Liu FK,et al. Comparison of two supplement oxygen methods during gastroscopy with intravenous propofol anesthesia in obese patients:study protocol for a randomized controlled trial[J].Trials,2018,19(1):602.
[79]
Goudra B,Gouda G,Singh PM. Recent Developments in Devices Used for Gastrointestinal Endoscopy Sedation[J]. Clin Endosc,2021,54(2):182-192.
[80]
Turnbull D. High-flow nasal oxygen, procedural sedation, and clinical governance[J]. Minerva Anestesiol,2022,88(5): 407-410.
[81]
Kang S,Lu J,Zhou HM. Anesthetic strategy for obese patients during gastroscopy: deep sedation or conscious sedation? A prospective randomized controlled trial[J]. J Anesth,2021,35(4):555-562.
[82]
Amornyotin S,Leelakusolvong S,Chalayonnawin W,et al. Agedependent safety analysis of propofol-based deep sedation for ERCP and EUS procedures at an endoscopy training center in a developing country[J].Clin Exp Gastroenterol,2012,5:123-128.
[83]
张凯,闫军.急性梗阻性化脓性胆管炎诊疗的研究进展[J].临床与病理杂志,2020,40(7):1902-1907.
[84]
Evans L,Rhodes A,Alhazzani W,et al.Surviving sepsis campaign:international guidelines for management of sepsis and septic shock 2021[J].Intensive Care Med,2021,47(11):1181-1247.
[85]
李鹏,王拥军,王文海. 中国ERCP 指南(2018 版)[J]. 中国医刊,2018,53(11):1185-1215.
[86]
Freeman ML,Nelson DB,Sherman S, et al. Complication of endoscopic biliary sphincterotomy[J]. N Engl J Med,1996,335(13):909-918.
[87]
Ikeuchi N, Itoi T, Gotoda T, et al. Feasibility of nonanesthesiologist-administered propofol sedation for emergency endoscopic retrograde cholangiopancreatography[J].Gastroenterol Res Pract,2015,685476.
No related articles found!
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?