title: A comparison of sedation protocols for gastric endoscopic submucosal dissection: moderate sedation with analgesic supplementation vs analgesia targeted light sedation.
abstract: BACKGROUND
  Moderate to deep sedation has been recommended during endoscopic submucosal dissection (ESD). However, it is often accompanied by adverse events such as respiratory depression or aspiration pneumonia. This study investigated the respiratory complications and ESD outcomes of two sedation protocols: moderate sedation with analgesic supplementation (MSAS) and analgesia targeted light sedation (ATLS).
  
  
  METHODS
  The clinical data of 293 patients who underwent ESD between May and December 2012 were reviewed. During the first 4 months, 155 patients were managed by moderate sedation [Modified Observer Assessment of Alertness/Sedation (MOAA/S) at 2-3] with the MSAS protocol. During the latter period, 138 patients were managed using the ATLS protocol (MOAA/S at 4-5). For both protocols, propofol and remifentanil were infused for sedation and pain control, respectively.
  
  
  RESULTS
  The ATLS protocol required less propofol [22.9 (sd 17.3) vs 88.1 (44.0) µg kg(-1) min(-1), P<0.001] and more remifentanil [6.8 (sd 3.1) vs 4.9 (3.0) µg kg(-1) hr(-1), P<0.001] than the MSAS protocol. The desaturation events during the procedure occurred significantly less often (2.2 vs 12.9%, P=0.001) and recovery was significantly faster [19.7 (sd 4.8) vs 27.9 (16.0) min, P<0.001] with the ATLS protocol than with the MSAS protocol. The incidence of aspiration pneumonia with the ATLS protocol was 1.4% compared with 5.2% with the MSAS protocol (P=0.109). There were no differences in outcomes and complications of ESD.
  
  
  CONCLUSIONS
  The ATLS protocol reduced the incidence of desaturation events without affecting ESD performance compared with the MSAS protocol. There was also a trend towards a low incidence of aspiration pneumonia with the ATLS protocol.
authors: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute.
authors: Y C
authors: YC
authors: Yoo
authors: Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors: C H
authors: CH
authors: Park
authors: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute.
authors: S
authors: S
authors: Shin
authors: Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors: Y
authors: Y
authors: Park
authors: Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea sklee@yuhs.ac ktmin501@yuhs.ac.
authors: S K
authors: SK
authors: Lee
authors: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute sklee@yuhs.ac ktmin501@yuhs.ac.
authors: K T
authors: KT
authors: Min
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000379:methods*; D000758:Anesthesia / Q000379:methods*; D000762:Anesthesia Recovery Period; D016292:Procedural Sedation / Q000379:methods*; D004724:Endoscopy; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D008875:Middle Aged; D010880:Piperidines; D011015:Pneumonia, Aspiration / Q000453:epidemiology; D015742:Propofol; D000077208:Remifentanil; D012189:Retrospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol
keywords: aspiration pneumonia; conscious sedation; endoscopy; moderate sedation