title: Salivary amylase activity is useful for assessing perioperative stress in response to pain in patients undergoing endoscopic submucosal dissection of gastric tumors under deep sedation.
abstract: BACKGROUND
  Although endoscopic submucosal dissection (ESD) for patients with gastric tumors under the conditions of unconsciousness is considered to be minimally invasive, no objective assessment of the perioperative stress of ESD has yet been conducted. Today, stress levels can be easily and objectively assessed by monitoring salivary amylase activity (sAMY). We evaluated the perioperative changes in the sAMY in patients undergoing ESD and identified the causes of such changes.
  
  
  METHODS
  A total of 40 patients with gastric cancers/adenomas removed by ESD under general anesthesia (GA; n = 20) and under deep sedation (DS; n = 20) were enrolled. sAMY was measured using the enzyme analysis equipment, sAMY Monitor (NIPRO, Osaka, Japan) during the perioperative period of the ESD. Also, all patients were interviewed to determine their subjective stress level, using a questionnaire asking "How did you feel during ESD?", with the choice of responses ranging from "did not wake up at all" to "I was awake and ESD was extremely stressful".
  
  
  RESULTS
  The sAMY of the DS group increased soon after the start of ESD. Meanwhile, that of the GA group decreased just after the ESD started and was maintained at a stable level throughout the ESD. In response to the stress level questionnaire, all of the patients in the GA group and a majority of the patients in the DS group responded, "did not wake up at all".
  
  
  CONCLUSIONS
  Sympathetic agitation, expressed as an increase of sAMY, was absent in the GA group. Meanwhile, in the DS group, some patients showed high levels of sAMY which went down following the administration of an analgesic agent, thus suggesting that pain caused an elevation in the level of the stress and thereby induced an increase in sAMY. The measurement of sAMY is therefore considered to be useful for the assessment of analgesic status under DS.
authors.affiliation: Department of Frontier Surgery (M9), Chiba University Graduate School of Medicine, Chiba, 260-8670, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Uesato
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nabeya
authors.forename: Takashi
authors.initials: T
authors.lastname: Akai
authors.forename: Masahito
authors.initials: M
authors.lastname: Inoue
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawahira
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Mamiya
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Ohta
authors.forename: Ryuji
authors.initials: R
authors.lastname: Motojima
authors.forename: Akiko
authors.initials: A
authors.lastname: Kagaya
authors.forename: Yorihiko
authors.initials: Y
authors.lastname: Muto
authors.forename: Hideki
authors.initials: H
authors.lastname: Hayashi
authors.forename: Hisahiro
authors.initials: H
authors.lastname: Matsubara
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery; D000368:Aged; D000681:Amylases / Q000378:metabolism*; D000700:Analgesics / Q000627:therapeutic use; D000768:Anesthesia, General; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D005773:Gastroscopy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000201:enzymology / Q000209:etiology; D019990:Perioperative Care / Q000379:methods; D012463:Saliva / Q000201:enzymology*; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013312:Stress, Physiological; D011795:Surveys and Questionnaires
chemical_list: D000700:Analgesics; D000681:Amylases