The impact of the use of general anesthesia on the results of endoscopic transpapillary interventions
Kuchynska I.1, Dronov O.2, Nastashenko I.2, Khinich H.3, Khrisanfov D.3
1Shupic National Medical Academy, Dept of Anaesthesiology & Intensive Care, Kyiv, Ukraine, 2Bogomolets National Medical University, Dept of Surgery, Kyiv, Ukraine, 3Kyiv City Clinical Hospital № 10, Surgery Center of Liver Disease, Biliary tract and Pancreas named by Zemskov VS., Dept of Anaesthesiology & Intensive Care, Kyiv, Ukraine
Background and Goal of Study: The high diagnostic value of Transpapillary endoscopic interventions (TEI) largely due to their invasiveness, which may contribute to adverse reactions and complications.We analyzed the influence of general anesthesia on the results of TEI and patient satisfaction.
Materials and Methods: In 2015, ETI were conducted in 697 patients: 315 (45.2%) were diagnostic, in 382 (54.8%) - treatment. In 631 (90.5%) patients was used local anesthesia of the pharynx and superficial sedation (benzodiazepine) by gastroenterologist (GDS group), in 66 (9.5%) -general anesthesia (propofol, phentanyl, rocuronium) - ADS group. In 2015 the proportion of patients with ADS increased by 6 times compared to the previous year: 11 (1.86%) in 2014 to 66 (9.5%) in 2015.To evaluate patient´s satisfaction with the endoscopy, we developed a questionnaire (Q=15) and asked the patients to fill it within 72 hours after the procedure. Response options were presented on a 7-point Likert scale. The degree of postoperative pain was evaluated by numerical pain scale (NPS) of 0 to 10. 
Results and Discussion: In GDS group duration of surgery was 61,50 ± 4,01 min, and in ADS group - 36,50 ± 2,84 min, p < 0.05. NPS in ADS group -1,89 ± 0,36 points, in GDS - 4,78 ± 0,65 (p < 0.05). The level of satisfaction manipulations by The Likert Scale in ADS - 6,100 ± 0,189 points, in the GDS group - 2,600 ± 0,281 p. Number of complications in GDS: bleeding after papillotomy - 2.4%, the progression of suppurative cholangitis - 1.6%, postoperative acute pancreatitis - 1.4%, duodenal perforation - 0.3%, the syndrome of "discharge" - 0.3%. In ADS 1 cases of bleeding after papillotomy (1.5%).
Conclusion(s): According to the our data, the use of general anesthesia in ETI provides patient satisfaction, reduces surgery duration almost twice (1.7 times), accelerates early activation of patients due to the minimum level of pain in the postoperative period (NPS 2 or less) and improves the technical conditions to perform ETI with affect the level of postoperative complications and significantly minimizes them.
References: Bannert C et al.Am J Gastroenterol.2012; 107:1837-1848.
Acknowledgements: Areshnikov D, chief of Department of Anesthesiology, died in July 2016.