title: Capnographic monitoring during endoscopic submucosal dissection with patients under deep sedation: a prospective, crossover trial of air and carbon dioxide insufflations.
abstract: OBJECTIVE
  The safety of carbon dioxide (CO(2)) insufflation has not been fully established for esophageal and gastric endoscopic submucosal dissection (ESD) under deep sedation, because CO(2) retention is not only caused by CO(2) insufflation but also by the sedation level and the patient's respiratory status. To clarify the clinical safety of CO(2) insufflation, we conducted a crossover trial of air and CO(2) insufflations.
  
  
  METHODS
  A total of 60 patients with early esophageal or gastric cancers underwent ESD during which insufflation was switched from CO(2) to air or from air to CO(2); transcutaneous partial pressure CO(2) (PtcCO(2)) was monitored in all patients. We also assessed respiratory function, arterial blood gas analysis, and smoking history.
  
  
  RESULTS
  Although significant increases in PtcCO(2) from baseline were observed, there were no significant differences in PtcCO(2) levels during CO(2) insufflation compared with levels during air insufflation in groups that received CO(2) preceding air or air preceding CO(2). All patients underwent ESD safely without adverse events, including 20 patients with subclinical respiratory dysfunction. The sedation protocol was the only significant predictor of CO(2) retention, independent of CO(2) insufflation.
  
  
  CONCLUSIONS
  CO(2) insufflation can be used as safely as air insufflation during ESD under deep sedation.
authors.affiliation: Department of Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences,  Niigata, Japan.
authors.forename: Akihito
authors.initials: A
authors.lastname: Takano
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Manabu
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Satoru
authors.initials: S
authors.lastname: Hashimoto
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Mizuno
authors.forename: Rintaro
authors.initials: R
authors.lastname: Narisawa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Aoyagi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000388:Air; D001785:Blood Gas Monitoring, Transcutaneous; D019296:Capnography; D002245:Carbon Dioxide / Q000009:adverse effects*; D016009:Chi-Square Distribution; D018592:Cross-Over Studies; D054810:Deep Sedation / Q000009:adverse effects*; D004210:Dissection; D004938:Esophageal Neoplasms / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D005773:Gastroscopy; D006801:Humans; D007327:Insufflation / Q000009:adverse effects* / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests; D012907:Smoking; D013274:Stomach Neoplasms / Q000601:surgery*
chemical_list: D002245:Carbon Dioxide