Reasonable decision of anesthesia methods in patients who underwent endoscopic submucosal dissection for superficial esophageal carcinoma: A retrospective analysis in a single Japanese institution

Kuwata, Naoko; Gotoda, Takuji; Suzuki, Shinichi; Mukai, Shuntaro; Itoi, Takao

doi:10.5152/tjg.2015.150186

Cited by 13 publications

(26 citation statements)

References 24 publications

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“…However, there are no reports about sedation during ESD for ESCC that indicate a higher rate of patients with heavy alcohol intake. On the other hand, it has been reported that general anesthesia is a safe and effective method during ESD for ESCC [25,26] . Therefore, general anesthesia may be an option in patients with risk factors for poor response to sedation, such as those who ingest excess alcohol or those with large lesions.…”

Section: Discussionmentioning

confidence: 98%

Prediction of Poor Response to Modified Neuroleptanalgesia with Midazolam for Endoscopic Submucosal Dissection for Esophageal Squamous Cell Carcinoma

Ominami¹,

Nagami²,

Shiba³

et al. 2016

Digestion

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Background/Aims: 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). Conclusion: Our study indicated that cumulative alcohol intake and major specimen size were associated with poor response to m-NLA with midazolam and pethidine hydrochloride.

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Section: Discussionmentioning

confidence: 98%

Prediction of Poor Response to Modified Neuroleptanalgesia with Midazolam for Endoscopic Submucosal Dissection for Esophageal Squamous Cell Carcinoma

Ominami¹,

Nagami²,

Shiba³

et al. 2016

Digestion

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“…While one study reported a favorable result for sedation [ 8 ], advanced esophageal endoscopy is generally performed under general anesthesia. Compared with endoscopic gastric procedures, minimal patient movement is more important during endoscopic esophageal procedures due to the anatomic differences [ 3 ]. Insufficient depth of sedation can lead to an unstable respiratory status or patient movement, which may result in complications such as perforation and hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the absence of patient movement, the major advantages of general anesthesia for endoscopic esophageal procedures include the reliability of the airway with tracheal intubation, a reduced risk of aspiration pneumonia, and the assistance of an anesthesiologist if complications occur [ 3 9 ]. As a result, more anesthesiologists are likely to encounter such patients in their daily practice.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with gastric ESD, the risk of perforation is greater for esophageal ESD, with perforation rates in gastric ESD ranging between 1.2% and 5.2% versus up to 10.7% in esophageal ESD [ 10 11 ]. Although one small retrospective study [ 3 ] reported a similar incidence of perforation between general anesthesia and sedation, it is uncertain whether anesthesia methods influence the risk of perforation during esophageal ESD. In comparison, the reported perforation rate in POEM ranges broadly from 0.4% to 14% [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Compared with endoscopic gastric procedures, endoscopic esophageal procedures carry an increased risk of perforation or bleeding due to the thinner esophageal wall, and motion with respiration and heartbeat in a narrow space [ 3 ]. Ventilatory support during these procedures is also challenging, as access to the patient's airway is not always readily achieved.…”

Section: Introductionmentioning

confidence: 99%

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The safety of endoscopic esophageal procedures under general anesthesia

Kim

Choi

et al. 2017

Korean J Anesthesiol

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BackgroundWith the increasing demand for general anesthesia for endoscopic esophageal procedures, anesthesiologists should understand the clinical characteristics of post-procedural complications (PPCs).MethodsWe retrospectively investigated the incidence of and risk factors associated with PPCs of endoscopic esophageal procedures performed under general anesthesia from July 2013 to November 2016. The final analysis included 129 patients; 114 who underwent esophageal endoscopic dissection for esophageal tumors and 15 cases of peroral endoscopic myotomy for achalasia. Frank perforation during the procedure was defined as an endoscopically recognizable or clinically detected perforation during the procedures. A multivariable logistic regression analysis was conducted to identify independent risk factors for PPCs.ResultsThe overall incidence of PPCs was 19.4% (25/129). All of the PPCs were managed successfully with conservative measures. The most common PPC was symptomatic, radiologically documented atelectasis (11/25, 44.0%), followed by esophageal perforation-related PPCs (symptomatic pneumomediastinum or pneumoperitoneum; 9/25, 36.0%). In the multivariable analysis, frank perforation during the procedure was the only independent risk factor for PPCs (odds ratio, 8.470, 95% CI, 2.051–34.974, P = 0.003). Although frank perforation during the procedure occurred in 13 patients, 38.5% (5/13) of them did not develop any clinical sequelae after their procedures. Compared with patients without PPCs, patients who developed PPCs took longer to their first oral intake and had prolonged hospital stays (P = 0.047 and 0.026, respectively).ConclusionsIatrogenic perforation during endoscopic esophageal procedures under general anesthesia was the only independent risk factor for PPCs; therefore, proactive measures and close follow-up are necessary.

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Feasibility of high‐flow nasal oxygen therapy and two‐stage sedation during endoscopic hypopharyngeal therapy

et al. 2020

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Background Structural disorders of the hypopharynx can lead to dysphagia‐related morbidity. Endoscopic therapy in this area, for example, myotomy for Zenker's diverticulum (ZD), has traditionally been performed under general anesthesia (GA). We have developed a two‐stage sedation process, which is used along with high‐flow nasal oxygen therapy (HFNOT) to facilitate endoscopic hypopharyngeal procedures. Methods In this prospective, single‐center study, patients undergoing endoscopic procedures between June 2016 and March 2018 were included. All endoscopies were performed with propofol and/or remifentanil and supported with HFNOT. In patients with ZD, the diverticulum and stomach were cleared of debris under conscious sedation to reduce the risk of aspiration, before sedation was deepened to facilitate myotomy. Sedation‐related adverse events were recorded. Results A total of 50 patients were included for analysis (mean age of 71.1, range 31–93; 58% male); 48% were categorized as American Society of Anesthesiologists (ASA) Grade III and 6% as Grade IV. The median procedure time was 20 min. Of patients, 83% were sedated with both propofol and remifentanil using a target‐controlled infusion under specialist anesthetic supervision. Sedation‐related adverse events included transient hypotension (38%), bradycardia (8%), and hypoxia (8%). No procedures were abandoned due to complications, and no patients required conversion to GA. Patients achieved full postprocedure recovery from sedation after a median duration of 5 min. Conclusions HFNOT is a useful adjunct to two‐stage sedation, which can enable high‐risk patients to safely undergo deep sedation during hypopharyngeal endoscopic procedures.

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Reasonable decision of anesthesia methods in patients who underwent endoscopic submucosal dissection for superficial esophageal carcinoma: A retrospective analysis in a single Japanese institution

Cited by 13 publications

References 24 publications

Prediction of Poor Response to Modified Neuroleptanalgesia with Midazolam for Endoscopic Submucosal Dissection for Esophageal Squamous Cell Carcinoma

Prediction of Poor Response to Modified Neuroleptanalgesia with Midazolam for Endoscopic Submucosal Dissection for Esophageal Squamous Cell Carcinoma

The safety of endoscopic esophageal procedures under general anesthesia

Feasibility of high‐flow nasal oxygen therapy and two‐stage sedation during endoscopic hypopharyngeal therapy

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