Sedation in gastroenterological endoscopy has become an important medical option in routine clinical care. Here, the Japan Gastroenterological Endoscopy Society and the Japanese Society of Anesthesiologists together provide the revised "Guidelines for sedation in gastroenterological endoscopy" as a second edition to address on-site clinical questions and issues raised for safe examination and treatment using sedated endoscopy. Twenty clinical questions were determined and the strength of recommendation and evidence quality (strength) were expressed according to the "MINDS Manual for Guideline Development 2017." We were able to release upto-date statements related to clinical questions and current issues relevant to sedation in gastroenterological endoscopy (henceforth, "endoscopy"). There are few reports from Japan in this field (e.g., meta-analyses), and many aspects have been based only on a specialist consensus. In the current scenario, benzodiazepine drugs primarily used for sedation during gastroenterological endoscopy are not approved by national health insurance in Japan, and investigations regarding expense-related disadvantages have not been conducted. Furthermore, including the perspective of beneficiaries (i.e., patients and citizens) during the creation of clinical guidelines should be considered. These guidelines are standardized based on up-to-date evidence quality (strength) and supports on-site clinical decision-making by patients and medical staff. Therefore, these guidelines need to be flexible with regard to the wishes, age, complications, and social conditions of the patient, as well as the conditions of the facility and discretion of the physician.

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.

mia-reperfusion not only damages the affected organ but also leads to remote organ injuries. Hepatic inflow interruption usually occurs during hepatic surgery. To investigate the influence of liver ischemiareperfusion on lung injury and to determine the contribution of tidal volume settings on liver ischemia-reperfusion-induced lung injury, we studied anesthetized and mechanically ventilated rats in which the hepatic inflow was transiently interrupted twice for 15 min. Two tidal volumes, 6 ml/kg as a low tidal volume (IR-LT) and 24 ml/kg as a high tidal volume (IR-HT), were assessed after liver ischemia-reperfusion, as well as after a sham operation, 6 ml/kg (NC-LT) and 24 ml/kg (NC-HT). Both the IR-HT and IR-LT groups had a gradual decline in the systemic blood pressure and a significant increase in plasma TNF-␣ concentrations. Of the four groups, only the IR-HT group developed lung injury, as assessed by an increase in the lung wet-to-dry weight ratio, the presence of significant histopathological changes, such as perivascular edema and intravascular leukocyte aggregation, and an increase in the bronchoalveolar lavage fluid TNF-␣ concentration. Furthermore, only in the IR-HT group was airway pressure increased significantly during the 6-h reperfusion period. These findings suggest that liver ischemia-reperfusion caused systemic inflammation and that lung injury is triggered when high tidal volume ventilation follows liver ischemia-reperfusion. acute lung injury; ventilator-induced lung injury; lung protective strategy; cytokines ISCHEMIA-REPERFUSION NOT ONLY damages the affected organ itself but can also cause systemic inflammation (32, 34). Such systemic inflammation may lead to remote organ injury and morbidity (20). Nevertheless, transient interruption of hepatic inflow is sometimes necessary during partial hepatectomy (10,14). The lung is one of the most susceptible organs to systemic inflammation-related injury, secondary to liver ischemiareperfusion (7,16,36), intestinal ischemia-reperfusion (6, 37), and renal ischemia-reperfusion (11,17).Acute lung injury (ALI), or acute respiratory distress syndrome (ARDS), is an important cause of mortality in critically ill patients. The mortality rate from ALI or ARDS is ϳ40 -50% (4, 31). In some cases, ALI or ARDS can be caused by extrapulmonary factors, such as systemic inflammation (5, 25) and sepsis (30,35). ALI/ARDS patients ventilated with low tidal volume ventilation have a lower mortality rate than those ventilated with high tidal volume ventilation (3, 4). There are in vivo and ex vivo studies that have analyzed the effect of tidal volume on ventilator-induced lung injury (VILI) following LPS administration (2, 28, 33) and cecal ligation and perforation (23); both of these induce severe systemic inflammation. As far as we know, there are no published papers that have explored the effect of different tidal volumes on VILI in connection with liver ischemia-reperfusion.To evaluate the effects of ventilation on lung injury induced by systemic inflammation follo...

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