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Patients with primary sclerosing cholangitis require more sedation during endoscopic retrograde cholangiography

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ABSTRACT

Background and study aims:  Patients with primary sclerosing cholangitis (PSC) require repeated endoscopic retrograde cholangiography (ERC). Our aim was to evaluate whether patients with PSC require higher doses of sedation during ERC.

Patients and methods:  We retrospectively analyzed all patients undergoing ERC from 2006 to 2013 who received conscious sedation with propofol and midazolam. The duration of the intervention and a potential progression of propofol consumption or intervention time by visit number were analyzed. Univariable and multivariable analyses were performed to identify independent factors which influence propofol consumption.

Results:  A total of 2962 ERC procedures were performed in 1211 patients. Patients with PSC (n = 157) underwent 461 ERC procedures whereas patients without PSC (n = 1054) had 2501 ERC examinations. The total median propofol dose was 450 mg (290 – 630 mg) for patients with PSC and 300 mg (200 – 450 mg) for the non-PSC group (P < 0.05). The propofol consumption in patients with PSC was increased by a factor of 1.24 (P = 0.0071) independent of intervention time. Younger age (< 60.8 years) and duration of the intervention were associated with a higher need for sedation by factors of 1.21 and 1.71, respectively (P < 0.0001). The robustness of the results was tested in a sensitivity analysis which confirmed the results (P < 0.0001).

Conclusions:  Patients with PSC may require higher doses of sedation for ERC compared to other patient groups independent of age and duration of ERC. The higher dosage of sedation has to be taken into account when using ERC to treat a patient with PSC.

No MeSH data available.


 Duration of ERC by visit number. No significant change in intervention time by intervention number was apparent. From intervention number 16, a longer intervention time was detected, but only seven patients had 16 or more interventions.
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FI637-1:  Duration of ERC by visit number. No significant change in intervention time by intervention number was apparent. From intervention number 16, a longer intervention time was detected, but only seven patients had 16 or more interventions.

Mentions: Patients with and without PSC received a median of 5 mg midazolam per ERC (IQR 5 – 5 mg for PSCand 3.15 – 5 mg for non-PSC patients, respectively; P = 0.0001). The analysis of the duration of ERC procedures showed no progression over time by visit number for all patients (up to 15 interventions) (Fig. 1). The total median propofol dose was 450 mg (290 – 630 mg) for patients with PSC and 300 mg (200 – 450 mg) for the non-PSC group (P < 0.05). The propofol consumption was equal over time and revealed no progression in the case of repeated ERC procedures for all patients (up to 15 interventions) (Fig. 2). The median time interval between repeat ERC examinations was 62 days (IQR 20 – 97 days). To exclude a potential progression of the propofol consumption or duration of ERC as a function of the time interval between repeat examinations, a pairwise linear correlation analysis was performed. No relevant correlation was identified for each of the first 11 visits (r < 0.5) (Table 2).


Patients with primary sclerosing cholangitis require more sedation during endoscopic retrograde cholangiography
 Duration of ERC by visit number. No significant change in intervention time by intervention number was apparent. From intervention number 16, a longer intervention time was detected, but only seven patients had 16 or more interventions.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC5383434&req=5

FI637-1:  Duration of ERC by visit number. No significant change in intervention time by intervention number was apparent. From intervention number 16, a longer intervention time was detected, but only seven patients had 16 or more interventions.
Mentions: Patients with and without PSC received a median of 5 mg midazolam per ERC (IQR 5 – 5 mg for PSCand 3.15 – 5 mg for non-PSC patients, respectively; P = 0.0001). The analysis of the duration of ERC procedures showed no progression over time by visit number for all patients (up to 15 interventions) (Fig. 1). The total median propofol dose was 450 mg (290 – 630 mg) for patients with PSC and 300 mg (200 – 450 mg) for the non-PSC group (P < 0.05). The propofol consumption was equal over time and revealed no progression in the case of repeated ERC procedures for all patients (up to 15 interventions) (Fig. 2). The median time interval between repeat ERC examinations was 62 days (IQR 20 – 97 days). To exclude a potential progression of the propofol consumption or duration of ERC as a function of the time interval between repeat examinations, a pairwise linear correlation analysis was performed. No relevant correlation was identified for each of the first 11 visits (r < 0.5) (Table 2).

View Article: PubMed Central - PubMed

ABSTRACT

Background and study aims: &ensp;Patients with primary sclerosing cholangitis (PSC) require repeated endoscopic retrograde cholangiography (ERC). Our aim was to evaluate whether patients with PSC require higher doses of sedation during ERC.

Patients and methods: &ensp;We retrospectively analyzed all patients undergoing ERC from 2006 to 2013 who received conscious sedation with propofol and midazolam. The duration of the intervention and a potential progression of propofol consumption or intervention time by visit number were analyzed. Univariable and multivariable analyses were performed to identify independent factors which influence propofol consumption.

Results: &ensp;A total of 2962 ERC procedures were performed in 1211 patients. Patients with PSC (n&#8202;=&#8202;157) underwent 461 ERC procedures whereas patients without PSC (n&#8202;=&#8202;1054) had 2501 ERC examinations. The total median propofol dose was 450&#8202;mg (290&#8202;&ndash;&#8202;630&#8202;mg) for patients with PSC and 300&#8202;mg (200&#8202;&ndash;&#8202;450&#8202;mg) for the non-PSC group (P&#8202;&lt;&#8202;0.05). The propofol consumption in patients with PSC was increased by a factor of 1.24 (P&#8202;=&#8202;0.0071) independent of intervention time. Younger age (&lt;&#8202;60.8 years) and duration of the intervention were associated with a higher need for sedation by factors of 1.21 and 1.71, respectively (P&#8202;&lt;&#8202;0.0001). The robustness of the results was tested in a sensitivity analysis which confirmed the results (P&#8202;&lt;&#8202;0.0001).

Conclusions: &ensp;Patients with PSC may require higher doses of sedation for ERC compared to other patient groups independent of age and duration of ERC. The higher dosage of sedation has to be taken into account when using ERC to treat a patient with PSC.

No MeSH data available.