Does previous COVID-19 severity affect propofol sedation safety during ERCP?: A prospective observational study

Endoscopic retrograde cholangiopancreatography (ERCP) requires deep sedation, typically with propofol, because of its rapid onset and recovery time. However, propofol can cause respiratory and hemodynamic instability. Because Coronavirus Disease 2019 (COVID-19) can induce long-term pulmonary and cardiovascular dysfunction, previous COVID-19 infection may influence sedation safety. This study aimed to evaluate the effects of COVID-19 infection severity on respiratory, hemodynamic, and recovery parameters during ERCP with propofol sedation. This prospective observational study included adult patients who underwent ERCP using propofol. Patients were divided into those without a COVID-19 history (COVID-) and those with a polymerase chain reaction-confirmed prior infection (COVID+), stratified by severity (mild, moderate, or severe). The primary outcome was hypoxemia (peripheral oxygen saturation < 90%). Secondary outcomes included apnea, airway interventions, hemodynamic instability, vasopressor use, recovery time, and patient complications. Multivariate logistic regression was used to adjust for confounders, including the American Society of Anesthesiologists physical status. A total of 326 patients were analyzed (163 COVID- and 163 COVID+ patients). Patients in the COVID+ group were classified as mild (n = 105), moderate (n = 46), or severe (n = 12). No significant differences were observed between the COVID and mild COVID+ groups in terms of hypoxemia or complications. Conversely, patients with a history of moderate or severe COVID-19 infection exhibited significantly higher rates of hypoxemia, apnea, airway interventions, vasopressor use, prolonged recovery, and postoperative oxygen requirements. Multivariate analysis identified a history of moderate-to-severe COVID-19 as an independent risk factor for hypoxemia. In conclusion, patients with a history of moderate or severe COVID-19 infection may be at increased risk for respiratory complications during propofol sedation for ERCP. Preoperative risk stratification should prioritize the severity of previous COVID-19 infection rather than just the history of infection.