Safety and efficacy of remifentanil-propofol combination on "muscle relaxant-free" general anesthesia for therapeutic endoscopic retrograde cholangiopancreatography: a randomized controlled trial

Objective: To prospectively evaluate the safety and efficacy of a "muscle relaxant-free" general anesthesia using a combination of remifentanil and propofol, compared to propofol-based monitored anesthesia care and conventional general anesthesia during therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Methods: From September to December 2019, 360 patients scheduled for elective ERCP at the Endoscopy Center of the First Affiliated Hospital of Nanjing Medical University were randomly assigned to three different groups: Group MAC (propofol-based monitored anesthesia care, n=120), Group GA(1) (general anesthesia with neuromuscular blocking agents, n=120), or Group GA(2) (remifentanil-propofol combination-based muscle relaxant-free general anesthesia, n=120). Results: The results showed that there was a significant difference in intraprocedural cardiopulmonary adverse events among the three groups (Group MAC, 37.5%; Group GA(1), 19.2%; Group GA(2), 17.5%; P < 0.001). Total time (from patient entry into the Endoscopy Center to departure) and room time (from patient entry into the endoscopy suit to departure) were shorter in Group GA(2) and Group MAC compared to Group GA(1) (P < 0.001). Additionally, endoscopist satisfaction levels were significantly higher in Group GA1 and Group GA(2) compared to Group MAC (P < 0.001). Conclusion: The study found that administering propofol-remifentanil combination for "muscle relaxant-free" general anesthesia during therapeutic ERCP was safe and effective. This approach offered greater safety and endoscopist satisfaction than propofol-based monitored anesthesia care, as well as shorter total time and room time than conventional general anesthesia.