title: Comparison of dexmedetomidine with on-demand midazolam versus midazolam alone for procedural sedation during endoscopic submucosal dissection of gastric tumor.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) is commonly performed as a treatment for gastric neoplasms. However, sedation with midazolam (MDZ) often does not reach satisfactory sedation levels during the procedure and the drug may suppress respiration and blood pressure. This study aimed to investigate the safety and efficacy of dexmedetomidine (DEX) with on-demand MDZ (the DEX group) in comparison with MDZ alone (the MDZ group) as a sedative during ESD of gastric neoplasms.
  
  
  METHODS
  Eighty patients undergoing ESD for gastric tumor were randomly assigned to one of two treatment regimens (40 patients in each). We investigated the depth of sedation by using a Modified Observers Assessment Alertness/Sedation score, the number of patients' reactions interfering with the procedure, sedation related-adverse events and the degree of satisfaction of patients and doctors.
  
  
  RESULTS
  There was no statistically significant difference between the two groups regarding their age, gender, body mass index, American Society of Anesthesiologists physical status classification and the characteristics of the tumor. Appropriate sedation rate and the degree of satisfaction of the doctors were significantly higher in the DEX group than in the MDZ group. Patients' reactions interfering with the procedure were more numerous in the MDZ group than in the DEX group. There was no significant difference in adverse events between the two groups.
  
  
  CONCLUSIONS
  DEX with on-demand MDZ for sedation during gastric ESD is as safe as MDZ alone and the sedation effect of DEX with MDZ is superior to that of MDZ alone.
authors.affiliation: Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Sang Pyo
authors.initials: SP
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: In-Kyung
authors.identifier: http://orcid.org/0000-0002-3848-5571
authors.initials: IK
authors.lastname: Sung
authors.affiliation: Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Jeong Hwan
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Sun-Young
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Hyung Seok
authors.initials: HS
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Chan Sup
authors.initials: CS
authors.lastname: Shim
authors.affiliation: Cardiac and Vascular Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Hweung Kon
authors.initials: HK
authors.lastname: Hwang
authors.affiliation: Department of Anesthesiology, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Tae-Yop
authors.initials: TY
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
authors.forename: Sang Goon
authors.initials: SG
authors.lastname: Shim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016292:Procedural Sedation / Q000379:methods* / Q000523:psychology; D020927:Dexmedetomidine / Q000008:administration & dosage*; D004210:Dissection / Q000379:methods; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D017060:Patient Satisfaction; D010820:Physicians / Q000523:psychology; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D008874:Midazolam
keywords: dexmedetomidine; endoscopic submucosal dissection; midazolam; procedural sedation; sedative agents