title: Diazepam during endoscopic submucosal dissection of gastric epithelial neoplasias.
abstract: OBJECTIVE
  To investigate risk factors and adverse events related to high-dose diazepam administration during endoscopic submucosal dissection for gastric neoplasias.
  
  
  METHODS
  Between February 2002 and December 2009, a total of 286 patients with gastric epithelial neoplasia underwent endoscopic submucosal dissection in our hospital. To achieve moderate sedation, 5-7.5 mg of diazepam was administered intravenously by non-anesthesiologists. Intermittent additional administration of 2.5-5 mg diazepam was performed if uncontrollable body movement of the patient was observed. All patients were classified into groups based on the required diazepam dose: low-dose (≤ 17.5 mg, n = 252) and high-dose (> 17.5 mg, n = 79).
  
  
  RESULTS
  Differences between the low- and high-dose diazepam groups were observed in lifetime alcohol consumption (0.30 ± 0.48 vs 0.44 ± 0.52 tons, P = 0.032), body weight (58.4 ± 10.3 vs 62.0 ± 9.9 kg, P = 0.006), tumor size (15 ± 10 vs 23 ± 18 mm, P < 0.001), lesion location (P < 0.001) and the presence of ulcerative findings (14/238 vs 18/61, P < 0.001). Multivariate analysis identified all five variables as independently related to required diazepam dosage. In terms of adverse reactions to diazepam administration, paradoxical excitement was significantly more frequent in the high-dose diazepam group (P < 0.001).
  
  
  CONCLUSIONS
  Intermittent administration of diazepam enabled safe completion of gastric endoscopic submucosal dissection except in patients who were alcohol abusers or obese, or who showed complicated lesions.
authors.affiliation: Yosuke Muraki, Shotaro Enomoto, Mikitaka Iguchi, Toru Niwa, Takao Maekita, Takeichi Yoshida, Kosaku Moribata, Naoki Shingaki, Hisanobu Deguchi, Kazuki Ueda, Izumi Inoue, Hideyuki Tamai, Jun Kato, Masao Ichinose, Second Department of Internal Medicine, Wakayama Medical University, Wakayama City, Wakayama 641-0012, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Muraki
authors.forename: Shotaro
authors.initials: S
authors.lastname: Enomoto
authors.forename: Mikitaka
authors.initials: M
authors.lastname: Iguchi
authors.forename: Toru
authors.initials: T
authors.lastname: Niwa
authors.forename: Takao
authors.initials: T
authors.lastname: Maekita
authors.forename: Takeichi
authors.initials: T
authors.lastname: Yoshida
authors.forename: Kosaku
authors.initials: K
authors.lastname: Moribata
authors.forename: Naoki
authors.initials: N
authors.lastname: Shingaki
authors.forename: Hisanobu
authors.initials: H
authors.lastname: Deguchi
authors.forename: Kazuki
authors.initials: K
authors.lastname: Ueda
authors.forename: Izumi
authors.initials: I
authors.lastname: Inoue
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tamai
authors.forename: Jun
authors.initials: J
authors.lastname: Kato
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Fujishiro
authors.forename: Masao
authors.initials: M
authors.lastname: Ichinose