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Safety and effectiveness of propofol‐based monitored anesthesia care without intubation during endoscopic submucosal dissection for early gastric and esophageal cancers
Author(s) -
aka Satoru,
Kawaguchi Yosuke,
Oda Ichiro,
Nakamura Jun,
Sato Chiko,
Kinjo Yuzuru,
Abe Seiichiro,
Suzuki Haruhisa,
Yoshinaga Shigetaka,
Sato Tetsufumi,
Saito Yutaka
Publication year - 2015
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12457
Subject(s) - medicine , sedation , propofol , endoscopic submucosal dissection , anesthesia , intubation , adverse effect , esophageal cancer , surgery , cancer
Background and Aim Endoscopic submucosal dissection ( ESD ) becomes more difficult with an increased risk of complications if patient sedation is insufficient. We assessed the safety and effectiveness of propofol‐based monitored anesthesia care ( MAC ) without intubation during ESD for early esophageal cancer ( EEC ) or early gastric cancer ( EGC ) in the endoscopy room. Methods We investigated 1013 consecutive patients with 1126 lesions who underwent ESD for EGC / EEC with either MAC or regular sedation by endoscopists (control group) between J uly 2010 and M arch 2013. Patient characteristics, endoscopic findings, technical results, body movement, oxygen saturation ( SpO 2 ), and drug dosages were then examined. Results MAC was carried out in 137 EGC (16%) and 82 EEC patients (57%), whereas regular sedation was used in 731 EGC (84%) and 63 EEC patients (43%). MAC was conducted in 21% of all ESD procedures. In the MAC and control groups, body movement requiring a third person for control occurred in 30 (22%) and 533 (72%) cases during gastric ESD ( P < 0.0001) and in 36 (44%) and 53 (84%) cases during esophageal ESD ( P < 0.0001), respectively. The median minimum SpO 2 was significantly lower in the MAC group than in the control group during both gastric and esophageal ESD (96% vs 98%, P < 0.0001; 96% vs 98%, P < 0.0004, respectively). MAC did not cause any adverse effects requiring prolongation of hospitalization. Conclusions Propofol‐based MAC without intubation provided a safer treatment environment by significantly reduced body movement and was very effective for difficult cases requiring longer procedure times or more powerful sedation.