title: Assessing the stability and safety of procedure during endoscopic submucosal dissection according to sedation methods: a randomized trial.
abstract: BACKGROUND
  Although endoscopic submucosal dissection (ESD) is routinely performed under sedation, the difference in ESD performance according to sedation method is not well known. This study attempted to prospectively assess and compare the satisfaction of the endoscopists and patient stability during ESD between two sedation methods.
  
  
  METHODS
  One hundred and fifty-four adult patients scheduled for ESD were sedated by either the IMIE (intermittent midazolam/propofol injection by endoscopist) or CPIA (continuous propofol infusion by anesthesiologist) method. The primary endpoint of this study was to compare the level of satisfaction of the endoscopists between the two groups. The secondary endpoints included level of satisfaction of the patients, patient's pain scores, events interfering with the procedure, incidence of unintended deep sedation, hemodynamic and respiratory events, and ESD outcomes and complications.
  
  
  RESULTS
  Level of satisfaction of the endoscopists was significantly higher in the CPIA Group compared to the IMIE group (IMIE vs. CPIA; high satisfaction score; 63.2% vs. 87.2%, P=0.001). The incidence of unintended deep sedation was significantly higher in the IMIE Group compared to the CPIA Group (IMIE vs. CPIA; 17.1% vs. 5.1%, P=0.018) as well as the number of patients showing spontaneous movement or those requiring physical restraint (IMIE vs. CPIA; spontaneous movement; 60.5% vs. 42.3%, P=0.024, physical restraint; 27.6% vs. 10.3%, P=0.006, respectively). In contrast, level of satisfaction of the patients were found to be significantly higher in the IMIE Group (IMIE vs. CPIA; high satisfaction score; 85.5% vs. 67.9%, P=0.027). Pain scores of the patients, hemodynamic and respiratory events, and ESD outcomes and complications were not different between the two groups.
  
  
  CONCLUSIONS
  Continuous propofol and remifentanil infusion by an anesthesiologist during ESD can increase the satisfaction levels of the endoscopists by providing a more stable state of sedation.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01806753.
authors: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors: Chan Hyuk
authors: CH
authors: Park
authors: Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Seokyung
authors: S
authors: Shin
authors: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors: Sang Kil
authors: SK
authors: Lee
authors: Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors: Hyuk
authors: H
authors: Lee
authors: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors: Yong Chan
authors: YC
authors: Lee
authors: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors: Jun Chul
authors: JC
authors: Park
authors: Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Young Chul
authors: YC
authors: Yoo
mesh_terms: D000368:Aged; D000777:Anesthetics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D054810:Deep Sedation / Q000009:adverse effects / Q000379:methods*; D004210:Dissection / Q000009:adverse effects / Q000379:methods; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D007267:Injections; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000777:Anesthetics; D008874:Midazolam; D015742:Propofol