High-flow nasal oxygen availability for sedation decreases the use of general anesthesia during endoscopic retrograde cholangiopancreatography and endoscopic ultrasound

Table 1 Patient characteristics and relative proportion of procedures between eras 1-3

Demographic	Era 1	Era 2	Era 3	P value
Age (yr)	61.1 ± 15.91	60.9 ± 15.9	62.2 ± 18.2	0.850
BMI (kg/m2)	28.1 ± 8.3	26.7 ± 7.4	26.3 ± 6.4	0.290
Gender (F), n (%)	28 (44.4)	45 (51.1)	53 (60.9)	0.120
ASA status 1-3	-	-	-	0.990
ERCP, n (%)	33 (52.4)	38 (43.2)	40 (46.0)	0.530
EUS, n (%)	30 (47.6)	50 (56.8)	47 (54.0)	0.530

¹Data in mean ± standard deviation. BMI: Body mass index; ERCP: Endoscopic retrograde cholangiopancreatography; EUS: Endoscopic ultrasound.

Table 2 Utilization of deep sedation vs general anesthesia and oxygenation during deep sedation between eras

Anesthesia type	Era 1	Era 2	Era 3	P value
DS, n (%)	41 (65.1)	73 (83.0)	61 (70.1)	0.033
GA, n (%)	22 (34.9)	15 (17.0)	26 (29.9)	0.033
DS only SpO2 nadir,	4.5 (98.0)	3.0 (99.0)a	4.0 (96.0)	< 0.001

There was a significantly lower utilization of GA in era 2 compared to era 1 (P = 0.012) that persisted as a trend only between eras 2 and 3 after Bonferroni correction (P = 0.045). There was a significantly lower median SpO₂ nadir in era 3 compared to era 2 (^aP < 0.001) that was a trend between eras 1 and 2 after Bonferroni correction (P = 0.028). DS: Deep sedation; GA: General anesthesia.

Table 3 Procedure times by era

Procedure	Era 1	Era 2	Era 3	P value
Combined ERCP/EUS	28.0, 23.0	26.0, 18.3	24.0, 21.3	0.340
ERCP only	30.0, 35.5	29.5, 32.0	29.5, 28.5	0.920
EUS only	25.0, 20.5	24.0, 15.2	19.0, 18.2	0.170
ERCP/EUS under DS	25.0, 18.0	26.0, 17.0	20.0, 18.7	≤ 0.007
ERCP/EUS under GA	40.5, 41.7	39.0, 28.0	30.5, 24.5	(time comparison within each era)

Values are given in medians and interquartile ranges. Time was assessed in minutes from procedure start to finish. There was no significant difference in procedure times between eras, but procedure times were significantly shorter under DS compared to GA within each era. ERCP: Endoscopic retrograde cholangiopancreatography; EUS: Endoscopic ultrasound; DS: Deep sedation; GA: General anesthesia.

Table 4 Anesthesia-only times between and within eras

Anesthesia time	Era 1	Era 2	Era 3	P value
ERCP/EUS combined	26.0, 37.5	23.5, 20.51	30.0, 28.0	0.006
ERCP	52.5, 48.2	31.0, 27.5	43.5, 32.0	0.080
EUS	20.0, 12.0	17.5, 10.22	23.0, 11.2	0.005
DS	21.0, 12.5	21.0, 13.0	24.0, 13.0	≤ 0.001
GA	68.0, 34.7	56.0, 13.0	59.0, 24.5	(time comparison within each era)

¹Anesthesia time was significantly shorter in era 2 compared to era 3 (P = 0.001);

²Anesthesia time for EUS was significantly shorter in era 2 compared to era 3 (P = 0.001). Values are given in medians and interquartile ranges. Anesthesia-only time was assessed in minutes from anesthesia start to finish after subtraction of the procedure time. ERCP: Endoscopic retrograde cholangiopancreatography; EUS: Endoscopic ultrasound; DS: Deep sedation; GA: General anesthesia.