title: Deep sedation in natural orifice transluminal endoscopic surgery (NOTES): a comparative study with dogs.
abstract: BACKGROUND
  Natural orifice transluminal endoscopic surgery (NOTES) has been mostly performed with the animal under general and inhalational anesthesia (IA-NOTES). To date, NOTES using propofol sedation (PS-NOTES) has not been investigated. This study aimed to assess the feasibility and safety of PS-NOTES for transgastric oophorectomy with carbon dioxide insufflation and to compare its success rates with those of conventional IA-NOTES.
  
  
  METHODS
  In this prospective randomized study, NOTES oophorectomy was performed for 19 female dogs randomized to two conditions: PS (study group) and IA (control group). Sedation success rates (ability to visualize and resect ovaries without converting to IA), operative success rates (ability to resect and retrieve both ovaries in full using only NOTES), and vital parameters including hemodynamic and respiratory changes were documented.
  
  
  RESULTS
  In the PS-NOTES group (n = 9), the sedation success rate was 100 %. The operative success rate was 67 % (6 of 9 animals) compared with 80 % (8 of 10 animals) in the IA-NOTES group. No purposeful movement occurred during surgical manipulation and no respiratory or cardiovascular complications in occurred the PS group. Heart rate (HR) and end-tidal carbon dioxide (ETCO(2)) were significantly higher in the PS group than in the IA group. Blood pressure (BP) was significantly higher in the PS group only during the middle part of the procedure. Only mild respiratory depression was noted in the PS group, as indicated by elevated but acceptable ETCO(2). Elevations in BP and HR are thought to be related to elevated CO(2) but did not appear to have an adverse impact on the course of the procedure. Recovery was uneventful for all the animals.
  
  
  CONCLUSIONS
  The use of PS-NOTES appears to be feasible, resulting in outcomes comparable with those for IA in dogs. Further studies are needed to determine the applicability of this concept in human NOTES.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Indiana University School of Medicine, 550 N University Boulevard, UH 4100, Indianapolis, IN 46202, USA. moalhadd@iupui.edu
authors.forename: Mohammad
authors.initials: M
authors.lastname: Al-Haddad
authors.forename: Daniel
authors.initials: D
authors.lastname: McKenna
authors.forename: Jeff
authors.initials: J
authors.lastname: Ko
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.forename: Don J
authors.initials: DJ
authors.lastname: Selzer
authors.forename: Samer G
authors.initials: SG
authors.lastname: Mattar
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Imperiale
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Rex
authors.forename: Attila
authors.initials: A
authors.lastname: Nakeeb
authors.forename: Seong Mok
authors.initials: SM
authors.lastname: Jeong
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Johnson
authors.forename: Lynetta J
authors.initials: LJ
authors.lastname: Freeman
mesh_terms: D000818:Animals; D054810:Deep Sedation; D004285:Dogs; D005240:Feasibility Studies; D005260:Female; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects; D011897:Random Allocation