Essential Components of Child Neurology Training: Program Director Consensus Recommendations.

Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive digestive endoscopic diagnostic and therapeutic procedure, which is regarded as the gold standard for the treatment of biliary or pancreatic duct diseases.[] In recent years, the application of therapeutic ERCP in elderly frail patients has increased increasingly, and the choice of anesthesia method directly affects the safety and effectiveness of the surgery. Currently, three anesthesia regimens are mainly used in clinical practice: conscious sedation, non-intubated general anesthesia, and intubated general anesthesia.[] Studies have shown that although conscious sedation is simple to operate, it is prone to sedation-related adverse events (such as hypoxemia and airway intervention) in elderly frail patients. Moreover, due to the age-related decline in multiple organ functions and poor drug tolerance, these patients have a higher risk of respiratory and circulatory complications.[] Meanwhile, under sedation, patients may experience discomfort or poor cooperation, which affects the surgical operation and leads to a decrease in the success rate of ERCP intubation and surgical completion rate. However, the general anesthesia regimen is also controversial. Some studies have pointed out that it may increase the risk of perioperative infections such as pneumonia, affect circulatory stability, cause delayed awakening, and aggravate the frailty burden of patients, making the choice of anesthesia a dilemma.[] In clinical practice, anesthesia decision-making is also constrained by practical conditions. In some regions with limited medical resources, general anesthesia is difficult to popularize due to the shortage of anesthesiologists and insufficient equipment, and conscious sedation has become a more common choice because of its simplicity of operation.[] In addition, elderly frail patients are often complicated with multiple underlying diseases. Especially during emergency ERCP, the condition is critical and individual differences are significant. Anesthesiologists need to comprehensively evaluate the patient’s vital signs, underlying conditions, surgical urgency, and medical conditions to formulate an individualized anesthesia plan. At present, there is still a lack of special studies on anesthesia for ERCP in elderly frail patients. Most of the existing evidence is extended from that of general elderly patients, and there is a lack of large-sample and high-quality studies targeting the “frail” state. The safety and effectiveness of various anesthesia methods have not been concluded.[] Therefore, it is urgent to carry out more in-depth studies to provide evidence for optimizing the anesthesia strategy for this group of patients. This study protocol was approved by the Hospital Ethics Committee (Ethics Approval No.: BFHHZS20230208; Chairman: Zhenchang Wang) and registered in the ClinicalTrials.gov (Registration No.: ; URL: ). The study population included patients scheduled for emergency ERCP with a FRAIL (Frail, Resistance, Ambulation, Illness, Loss of weight) scale score ≥3. Before the procedure, the process, risks, and study details of the two anesthesia regimens were fully explained to eligible patients and their families. The principle of voluntariness and the right to withdraw at any time were emphasized, and written informed consent was obtained.