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Efficacy and safety of sedation during endoscopic submucosal dissection of gastric cancers using a comparative trial of propofol versus midazolam

BACKGROUND AND STUDY AIMS : Proper sedation is necessary for the safe and satisfactory completion of endoscopic submucosal dissection (ESD) for early gastric cancer. This study was conducted as a comparative trial of efficacy and safety, comparing propofol-based sedation and midazolam-based sedation...

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Autores principales: Kikuchi, Hitomi, Hikichi, Takuto, Watanabe, Ko, Nakamura, Jun, Takagi, Tadayuki, Suzuki, Rei, Sugimoto, Mitsuru, Waragai, Yuichi, Konno, Naoki, Asama, Hiroyuki, Takasumi, Mika, Sato, Yuki, Obara, Katsutoshi, Ohira, Hiromasa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: © Georg Thieme Verlag KG 2018
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5766337/
https://www.ncbi.nlm.nih.gov/pubmed/29340298
http://dx.doi.org/10.1055/s-0043-122225
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author Kikuchi, Hitomi
Hikichi, Takuto
Watanabe, Ko
Nakamura, Jun
Takagi, Tadayuki
Suzuki, Rei
Sugimoto, Mitsuru
Waragai, Yuichi
Konno, Naoki
Asama, Hiroyuki
Takasumi, Mika
Sato, Yuki
Obara, Katsutoshi
Ohira, Hiromasa
author_facet Kikuchi, Hitomi
Hikichi, Takuto
Watanabe, Ko
Nakamura, Jun
Takagi, Tadayuki
Suzuki, Rei
Sugimoto, Mitsuru
Waragai, Yuichi
Konno, Naoki
Asama, Hiroyuki
Takasumi, Mika
Sato, Yuki
Obara, Katsutoshi
Ohira, Hiromasa
author_sort Kikuchi, Hitomi
collection PubMed
description BACKGROUND AND STUDY AIMS : Proper sedation is necessary for the safe and satisfactory completion of endoscopic submucosal dissection (ESD) for early gastric cancer. This study was conducted as a comparative trial of efficacy and safety, comparing propofol-based sedation and midazolam-based sedation during ESD of early gastric cancer patients. PATIENTS AND METHODS : This study examined 64 lesions in 58 patients treated using ESD with midazolam plus pentazocine between July 2013 and January 2014 (group M) and 237 lesions in 216 patients treated by ESD using propofol plus pentazocine between February 2014 and December 2015 (group P). The two groups were compared in terms of the frequency of body movement during ESD as the primary outcome and in terms of the procedure time, en bloc resection rate, intraoperative change in cardiorespiratory dynamics, and postoperative awareness as the secondary outcomes. Body movement was defined as movement by a patient that required interruption of the procedure or restraint of the patient’s body trunk, and addition of a sedative agent. RESULTS : The median frequency of body movement during ESD was significantly lower in group P (0 times) than in group M (3 times) ( P  < 0.001). No significant difference was found for the mean procedure time (117 min in group P; 127 min in group M). Although no significant difference was found in the incidence of hypoxemia, bradycardia, or bradypnea, the incidence of hypotension was significantly higher in group P (31.5 %) than in group M (6.9 %) ( P  = 0.004). Patients in group P had significantly higher postoperative awareness immediately after ESD and at 1 hour after ESD ( P  = 0.002 and 0.022, respectively). CONCLUSION : These results demonstrate the efficacy and safety of propofol-based sedation for gastric ESD.
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spelling pubmed-57663372018-01-16 Efficacy and safety of sedation during endoscopic submucosal dissection of gastric cancers using a comparative trial of propofol versus midazolam Kikuchi, Hitomi Hikichi, Takuto Watanabe, Ko Nakamura, Jun Takagi, Tadayuki Suzuki, Rei Sugimoto, Mitsuru Waragai, Yuichi Konno, Naoki Asama, Hiroyuki Takasumi, Mika Sato, Yuki Obara, Katsutoshi Ohira, Hiromasa Endosc Int Open BACKGROUND AND STUDY AIMS : Proper sedation is necessary for the safe and satisfactory completion of endoscopic submucosal dissection (ESD) for early gastric cancer. This study was conducted as a comparative trial of efficacy and safety, comparing propofol-based sedation and midazolam-based sedation during ESD of early gastric cancer patients. PATIENTS AND METHODS : This study examined 64 lesions in 58 patients treated using ESD with midazolam plus pentazocine between July 2013 and January 2014 (group M) and 237 lesions in 216 patients treated by ESD using propofol plus pentazocine between February 2014 and December 2015 (group P). The two groups were compared in terms of the frequency of body movement during ESD as the primary outcome and in terms of the procedure time, en bloc resection rate, intraoperative change in cardiorespiratory dynamics, and postoperative awareness as the secondary outcomes. Body movement was defined as movement by a patient that required interruption of the procedure or restraint of the patient’s body trunk, and addition of a sedative agent. RESULTS : The median frequency of body movement during ESD was significantly lower in group P (0 times) than in group M (3 times) ( P  < 0.001). No significant difference was found for the mean procedure time (117 min in group P; 127 min in group M). Although no significant difference was found in the incidence of hypoxemia, bradycardia, or bradypnea, the incidence of hypotension was significantly higher in group P (31.5 %) than in group M (6.9 %) ( P  = 0.004). Patients in group P had significantly higher postoperative awareness immediately after ESD and at 1 hour after ESD ( P  = 0.002 and 0.022, respectively). CONCLUSION : These results demonstrate the efficacy and safety of propofol-based sedation for gastric ESD. © Georg Thieme Verlag KG 2018-01 2018-01-12 /pmc/articles/PMC5766337/ /pubmed/29340298 http://dx.doi.org/10.1055/s-0043-122225 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Kikuchi, Hitomi
Hikichi, Takuto
Watanabe, Ko
Nakamura, Jun
Takagi, Tadayuki
Suzuki, Rei
Sugimoto, Mitsuru
Waragai, Yuichi
Konno, Naoki
Asama, Hiroyuki
Takasumi, Mika
Sato, Yuki
Obara, Katsutoshi
Ohira, Hiromasa
Efficacy and safety of sedation during endoscopic submucosal dissection of gastric cancers using a comparative trial of propofol versus midazolam
title Efficacy and safety of sedation during endoscopic submucosal dissection of gastric cancers using a comparative trial of propofol versus midazolam
title_full Efficacy and safety of sedation during endoscopic submucosal dissection of gastric cancers using a comparative trial of propofol versus midazolam
title_fullStr Efficacy and safety of sedation during endoscopic submucosal dissection of gastric cancers using a comparative trial of propofol versus midazolam
title_full_unstemmed Efficacy and safety of sedation during endoscopic submucosal dissection of gastric cancers using a comparative trial of propofol versus midazolam
title_short Efficacy and safety of sedation during endoscopic submucosal dissection of gastric cancers using a comparative trial of propofol versus midazolam
title_sort efficacy and safety of sedation during endoscopic submucosal dissection of gastric cancers using a comparative trial of propofol versus midazolam
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5766337/
https://www.ncbi.nlm.nih.gov/pubmed/29340298
http://dx.doi.org/10.1055/s-0043-122225
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