title: Safety and effectiveness of propofol-based monitored anesthesia care without intubation during endoscopic submucosal dissection for early gastric and esophageal cancers.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) becomes more difficult with an increased risk of complications if patient sedation is insufficient. We assessed the safety and effectiveness of propofol-based monitored anesthesia care (MAC) without intubation during ESD for early esophageal cancer (EEC) or early gastric cancer (EGC) in the endoscopy room.
  
  
  METHODS
  We investigated 1013 consecutive patients with 1126 lesions who underwent ESD for EGC/EEC with either MAC or regular sedation by endoscopists (control group) between July 2010 and March 2013. Patient characteristics, endoscopic findings, technical results, body movement, oxygen saturation (SpO2 ), and drug dosages were then examined.
  
  
  RESULTS
  MAC was carried out in 137 EGC (16%) and 82 EEC patients (57%), whereas regular sedation was used in 731 EGC (84%) and 63 EEC patients (43%). MAC was conducted in 21% of all ESD procedures. In the MAC and control groups, body movement requiring a third person for control occurred in 30 (22%) and 533 (72%) cases during gastric ESD (P < 0.0001) and in 36 (44%) and 53 (84%) cases during esophageal ESD (P < 0.0001), respectively. The median minimum SpO2 was significantly lower in the MAC group than in the control group during both gastric and esophageal ESD (96% vs 98%, P < 0.0001; 96% vs 98%, P < 0.0004, respectively). MAC did not cause any adverse effects requiring prolongation of hospitalization.
  
  
  CONCLUSIONS
  Propofol-based MAC without intubation provided a safer treatment environment by significantly reduced body movement and was very effective for difficult cases requiring longer procedure times or more powerful sedation.
authors: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors: Satoru
authors: S
authors: Nonaka
authors: Departments of Anesthesiology and Critical Care Medicine, National Cancer Center Hospital, Tokyo, Japan.
authors: Yosuke
authors: Y
authors: Kawaguchi
authors: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors: Ichiro
authors: I
authors: Oda
authors: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors: Jun
authors: J
authors: Nakamura
authors: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors: Chiko
authors: C
authors: Sato
authors: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors: Yuzuru
authors: Y
authors: Kinjo
authors: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors: Seiichiro
authors: S
authors: Abe
authors: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors: Haruhisa
authors: H
authors: Suzuki
authors: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors: Shigetaka
authors: S
authors: Yoshinaga
authors: Departments of Anesthesiology and Critical Care Medicine, National Cancer Center Hospital, Tokyo, Japan.
authors: Tetsufumi
authors: T
authors: Sato
authors: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors: Yutaka
authors: Y
authors: Saito
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D054810:Deep Sedation / Q000009:adverse effects / Q000379:methods*; D004210:Dissection / Q000379:methods; D055088:Early Detection of Cancer; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D007442:Intubation, Intratracheal; D007564:Japan; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D008991:Monitoring, Physiologic / Q000379:methods; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D015742:Propofol
keywords: body movements; endoscopic submucosal dissection; monitored anesthesia care; propofol