title: Prediction of Poor Response to Modified Neuroleptanalgesia with Midazolam for Endoscopic Submucosal Dissection for Esophageal Squamous Cell Carcinoma.
abstract: OBJECTIVE
  Modified neuroleptanalgesia (m-NLA) with midazolam is often used for sedation and analgesia during endoscopic submucosal dissection (ESD) for gastrointestinal neoplasia. However, interruption due to poor response to midazolam is often experienced during ESD for esophageal squamous cell carcinoma (ESCC) because most patients with ESCC have a history of heavy alcohol intake. We examined the incidence and risk factors for poor response to m-NLA with midazolam and pethidine hydrochloride.
  
  
  METHODS
  This retrospective cross-sectional study was conducted at a single institution. Between April 2007 and July 2013, 151 patients with superficial ESCC who underwent ESD under sedation using m-NLA with midazolam and pethidine hydrochloride were enrolled. Poor response to sedation was defined as the use of a second drug when Ramsay Sedation Score 1-2.
  
  
  RESULTS
  Poor response to sedation occurred in 66.2% patients. Most cases of poor response were controlled by using additional flunitrazepam. Multivariate logistic regression analysis showed that cumulative alcohol intake and major specimen size were independent risk factors for poor response to sedation (OR 3.63, 95% CI 1.20-10.99, and OR 3.23, 95% CI 1.26-8.25).
  
  
  CONCLUSIONS
  Our study indicated that cumulative alcohol intake and major specimen size were associated with poor response to m-NLA with midazolam and pethidine hydrochloride.
authors.affiliation: Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Ominami
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Nagami
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Shiba
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tominaga
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Maruyama
authors.forename: Junichi
authors.initials: J
authors.lastname: Okamoto
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Kato
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Minamino
authors.forename: Shusei
authors.initials: S
authors.lastname: Fukunaga
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sugimori
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Yamagami
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tanigawa
authors.forename: Toshio
authors.initials: T
authors.lastname: Watanabe
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Arakawa
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage; D000368:Aged; D000437:Alcoholism / Q000150:complications; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D003430:Cross-Sectional Studies; D000069916:Endoscopic Mucosal Resection; D004938:Esophageal Neoplasms / Q000601:surgery*; D000077277:Esophageal Squamous Cell Carcinoma; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008614:Meperidine / Q000008:administration & dosage; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D009458:Neuroleptanalgesia / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000759:Adjuvants, Anesthesia; D006993:Hypnotics and Sedatives; D008614:Meperidine; D008874:Midazolam