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A comparison of sedation protocols for gastric endoscopic submucosal dissection: moderate sedation with analgesic supplementation vs analgesia targeted light sedation

 Y. C. Yoo  ;  C. H. Park  ;  S. Shin  ;  Y. Park  ;  S. K. Lee  ;  K. T. Min 
 British Journal of Anaesthesia, Vol.115(1) : 84-88, 2015 
Journal Title
 British Journal of Anaesthesia 
Issue Date
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. CONCLUSION: 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.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
민경태(Min, Kyeong Tae) ORCID logo https://orcid.org/0000-0002-3299-4500
박예현(Park, Yehyun) ORCID logo https://orcid.org/0000-0001-8811-0631
박찬혁(Park, Chan Hyuk)
신서경(Shin, Seokyung) ORCID logo https://orcid.org/0000-0002-2641-0070
유영철(Yoo, Young Chul) ORCID logo https://orcid.org/0000-0002-6334-7541
이상길(Lee, Sang Kil) ORCID logo https://orcid.org/0000-0002-0721-0364
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