Conscious sedation as a potential optimal anesthetic regimen for endoscopic retrograde cholangiopancreatography in elderly frail patients: A prospective, single-blind, randomized controlled trial

ABSTRACT Objective: To investigate the impact of adverse cardiovascular events (ACVs) in elderly frail patients undergoing emergency endoscopic retrograde cholangiopancreatography (ERCP), and to explore a safe and comfortable anesthetic regimen suitable for this specific population. Materials and Methods: A single-center, prospective, single-blind, randomized controlled trial was conducted. Patients aged 70–90 years scheduled for emergency ERCP were enrolled and randomly divided into two groups: the conscious sedation group (Group S) and the intravenous general anesthesia group (Group A). Basic clinical data of the patients were recorded. During ERCP, the occurrence of ACVs was documented, including hemodynamic fluctuations exceeding 20% of the baseline value, angina pectoris, myocardial infarction, cardiac arrest, acute heart failure, myocardial ischemia, pulmonary embolism, and various arrhythmias. Additionally, adverse reactions such as hypoxemia, body movement, and cough during the procedure were monitored. The effects of different anesthetic methods on ACVs in elderly frail patients undergoing emergency ERCP were compared, and the satisfaction of patients, anesthesiologists, and endoscopists was evaluated. Results: A total of 108 patients undergoing emergency ERCP were enrolled and randomly assigned to Group S ( n = 53) and Group A ( n = 55). The results showed that there was a statistically significant difference in the incidence of ACVs between the two groups (17% vs. 40%, P < 0.05). Compared with Group A, Group S had a significantly lower incidence of blood pressure and heart rate fluctuations ≥20% of the baseline value (13.2% vs. 25.5%, P < 0.05), and new-onset arrhythmias (5.7% vs. 18.2%, P < 0.05). Conclusion: Compared with intravenous general anesthesia, conscious sedation can reduce fluctuations in blood pressure and heart rate, and decrease the incidence of adverse cardiovascular events in elderly frail patients undergoing emergency ERCP.