Safety and Efficacy of Deep Sedation with Propofol Alone or Combined with Midazolam Administrated by Nonanesthesiologist for Gastric Endoscopic Submucosal Dissection

Abstract

Background/AimsEndoscopic submucosal dissection (ESD) is accepted as a treatment for gastric neoplasms and usually requires deep sedation. The aim of this study was to evaluate the safety and efficacy profiles of deep sedation induced by continuous propofol infusion with or without midazolam during ESD.MethodsA total of 135 patients scheduled for ESDs between December 2008 and June 2010 were included in this prospective study and were randomly assigned to one of two groups: the propofol group or the combination group (propofol plus midazolam).ResultsThe propofol group reported only one case of severe hypoxemia with no need of mask ventilation or intubation. Additionally, 18 cases of mild hypotension were observed in the propofol group, and 11 cases were observed in the combination group. The combination group had a lower mean total propofol dose (378 mg vs 466 mg, p<0.012), a longer mean recovery time (10.5 minutes vs 7.9 minutes, p=0.027), and a lower frequency of overall adverse events (32.8% vs 17.6%, p=0.042).ConclusionsDeep sedation induced by continuous propofol infusion was shown to be safe during ESD. The combination of continuous propofol infusion and intermittent midazolam injection can decrease the total dose and infusion rate of propofol and the overall occurrence of adverse events.

Short- and long-term outcomes of endoscopic submucosal dissection for early gastric cancer in elderly patients aged 75 years and older

“…Although ESD is generally accepted as a safe treatment, it carries some risks for elderly patients with comorbidities because of the long procedure time (with deep sedation) and procedure-related complications [24][25][26][27][28]. Therefore, in considering the indications for ESD in elderly patients, we must keep in mind their general condition, including the severity of comorbidities and PS score.…”

A clinical trial comparing propofol versus propofol plus midazolam in diagnostic endoscopy of patients with a low anesthetic risk

“…These evoke a synergetic action, without increasing the side effects and reduce the total required dose of propo-fol (25,26). This protocol, which aims to achieve a moderate-profound sedation level, has been described in the recent medical literature as "balanced propofol sedation" (BPS) (27)(28)(29) and has been compared to propofol administration as the only sedative (29)(30)(31)(32)(33).…”

Feasibility of deep sedation with a combination of propofol and dexmedetomidine hydrochloride for esophageal endoscopic submucosal dissection

“…22 As the incidence of complications relevant to sedative agents is closely related to the given dose, several attempts to reduce the dose have been reported. 23 More recently, the introduction of DEX has attracted considerable attention for sedation during gastrointestinal endoscopy. 24 DEX is a short-acting selective alpha 2-adrenergic receptor agonist primarily acting on the locus ceruleus of the pons and possesses anxiolytic, hypnotic, and analgesic properties.…”