STUDY PROTOCOL article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Effect of Deep Analgosedation versus Intubated General Anesthesia on Perioperative Sedation-Related Adverse Events in Older Adults Undergoing ERCP: Protocol for a Randomized Controlled Trial
1. Sir Run Run Shaw Hospital, School of Medicine, Graduate School, Zhejiang University, Hangzhou, China
2. Suzhou Xiangcheng People's Hospital, Suzhou, China
3. Hangzhou First People's Hospital, Hangzhou, China
4. The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Abstract
Background: Deep analgosedation (DAS) and general anesthesia (GA) are currently the predominant anesthetic approaches for endoscopic retrograde cholangiopancreatography (ERCP). In contrast to DAS, GA typically requires endotracheal intubation for airway management. To determine the optimal analgosedation strategy, this study is designed to compare the effect of nasopharyngeal airway-assisted DAS (NPA-assisted DAS) versus endotracheal intubation GA on perioperative sedation-related adverse events (SRAEs) in elderly ERCP patients. Methods: Patients scheduled for ERCP will be randomly assigned in a 1:1 ratio to NAP-assisted DAS or endotracheal intubation GA. Randomization will be stratified by study center and hypertension status, using permuted blocks of sizes 2 and 4. The major exclusion criterion is severe cardiopulmonary disease. The primary outcome is a composite of SRAEs, including hypoxemia, hypotension, hypertension, laryngospasm, or bronchospasm. Secondary outcomes include escalation of respiratory support, tachycardia, bradycardia, reflux, recovery time, postoperative recovery quality (QoR-15), postoperative nausea and vomiting (PONV), cognitive function, perioperative respiratory failure or acute respiratory distress syndrome (ARDS), patient and endoscopist satisfaction, and length of hospital stay. All analyses will follow a modified intention-to-treat approach. Ethics and dissemination Ethics approval was obtained from the Ethics Committee of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine (2025-0780). Written informed consent will be obtained from all participants prior to enrollment. The findings of this trial will be disseminated through publication in a peer-reviewed journal.
Summary
Keywords
Deep analgosedation, ERCP, general anesthesia, NPA-assisted DAS, Perioperative sedation relatedadverse events
Received
10 December 2025
Accepted
11 February 2026
Copyright
© 2026 Lv, Xu, Sun, Liu, Yu and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Gang Chen
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