Safe and effective sedation in endoscopic submucosal dissection for early gastric cancer: a randomized comparison between propofol continuous infusion and intermittent midazolam injection

• Published in: Journal of gastroenterology 2010-08, Vol.45 (8), p.831-837
• Main Authors: Kiriyama, Shinsuke, Gotoda, Takuji, Sano, Hiromi, Oda, Ichiro, Nishimoto, Fumiya, Hirashima, Tetsuro, Kusano, Chika, Kuwano, Hiroyuki
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Aged; Aged, 80 and over; Analysis; Anesthesia Recovery Period; Anesthetics, Intravenous - administration & dosage; Anesthetics, Intravenous - adverse effects; Anesthetics, Intravenous - therapeutic use; Cancer; Care and treatment; Colorectal Surgery; Conscious Sedation - adverse effects; Conscious Sedation - methods; Deep Sedation - adverse effects; Deep Sedation - methods; Drug Administration Schedule; Endoscopic submucosal dissection; Endoscopy; Endoscopy - methods; Female; Gastric Mucosa - pathology; Gastric Mucosa - surgery; Gastroenterology; Heart beat; Hepatology; Humans; Hypnotics and Sedatives - administration & dosage; Hypnotics and Sedatives - adverse effects; Hypnotics and Sedatives - therapeutic use; Infusions, Intravenous; Male; Medicine; Medicine & Public Health; Midazolam; Midazolam - administration & dosage; Midazolam - adverse effects; Midazolam - therapeutic use; Middle Aged; Original Article—Alimentary Tract; Patients; Phenols; Propofol; Propofol - administration & dosage; Propofol - adverse effects; Propofol - therapeutic use; Prospective Studies; sedation; Stomach cancer; Stomach Neoplasms - surgery; Surgery; Surgical Oncology
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-010-0222-8

Purpose Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) generally takes longer to perform than conventional endoscopy and usually requires moderate/deep sedation with close surveillance for patient safety. The aim of this study was to compare the safety profiles and recovery scores propofol continuous infusion and intermittent midazolam (MDZ) injection as sedation for ESD. Methods Sixty EGC patients scheduled for ESDs between August and November 2008 were included in this prospective study and randomly divided into a propofol (P-group, 28 patients) and an MDZ (M-group, 32 patients) group using an odd-even system. The P-group received a 0.8 mg/kg induction dose and a 3 mg/kg/h maintenance dose of 1% propofol using an infusion pump. All patients received 15 mg pentazocine at the start of the ESD and at 60-min intervals thereafter. We recorded and analyzed blood pressure, oxygen saturation and heart rate during and following the procedure and evaluated post-anesthetic recovery scores (PARS) and subsequent alertness scores. Results The propofol maintenance and total dose amounts were (mean ± standard deviation) 3.7 ± 0.6 mg/kg/h and 395 ± 202 mg, respectively. The mean total dose of MDZ was 10.3 ± 4.5 mg. There were no cases of de-saturation