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Safety of prone emergence from general endotracheal anesthesia in patients undergoing ERCP: a randomized controlled trial

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Abstract

Background

Conventional supine emergence and prone extubation from general endotracheal anesthesia (GEA) are associated with extubation-related adverse events (ERAEs). Given the minimally invasive nature of endoscopic retrograde cholangiopancreatography (ERCP) as well as the improved ventilation/perfusion matching and easier airway opening in the prone position, we aimed to assess the safety of prone emergence and extubation in patients undergoing ERCP under GEA.

Methods

Totally, 242 eligible patients were recruited and randomized into the supine extubation group (n = 121; supine group) and the prone extubation group (n = 121; prone group). The primary endpoint was the incidence of ERAEs during emergence, including hemodynamic fluctuations, coughing, stridor, and hypoxemia requiring airway maneuvers. The secondary endpoints included the incidence of monitoring disconnections, extubation time, recovery time, room exit time, and post-procedure sore throat.

Results

The incidence of ERAEs was significantly lower in the prone group compared with the supine group (8.3% vs 34.7%, OR = 0.17, 95% CI 0.18–0.56; P < 0.001). Moreover, the prone group demonstrated no monitoring disconnections, shorter extubation time and room exit time, faster recovery, and, lower frequency and milder sore throat after the procedure.

Conclusions

For patients undergoing ERCP under GEA, compared with supine, prone emergence, and extubation had remarkably lower rates of EAREs and better recovery, and can maintain continuous monitoring and improve efficiency.

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Acknowledgements

None.

Funding

This work was supported by the Research project of Shanghai Municipal Health Commission (201940062) and the National Natural Science Foundation of China (81774108 and 81973652).

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Author notes

  1. Jin-hui Xiang and Pan Wei have contributed equally to the study and are co-first authors.

Authors and Affiliations

  1. Department of Anesthesiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, No. 528 Zhangheng Road, Shanghai, 201203, China

    Jin-hui Xiang, Pan Wei, Yu-jiao Zhang, Li-li Li, Xing Li, Jian Wang, Jian Xie, Yong Zhong, Hao Gao, Lan Yuan, Wen-ting Chen & Jian-gang Song

  2. Acupuncture and Anesthesia Research Institute, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China

    Wen-ting Chen & Jian-gang Song

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  1. Jin-hui Xiang
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Correspondence to Wen-ting Chen or Jian-gang Song.

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Disclosures

Jin-hui Xiang, Pan Wei, Yu-jiao Zhang, Li-li Li, Xing Li, Jian Wang, Jian Xie, Yong Zhong, Hao Gao, Lan Yuan, Wen-ting Chen, and Jian-gang Song have no conflicts of interest or financial ties to disclose.

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Xiang, Jh., Wei, P., Zhang, Yj. et al. Safety of prone emergence from general endotracheal anesthesia in patients undergoing ERCP: a randomized controlled trial. Surg Endosc 37, 7493–7501 (2023). https://doi.org/10.1007/s00464-023-10187-7

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  • DOI: https://doi.org/10.1007/s00464-023-10187-7

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