Propofol-Based Sedation Versus General Anesthesia for Endoscopic Submucosal Dissection

The main objective of this study is to evaluate general anesthesia or propofol-based sedation methods at gastric endoscopic submucosal dissection (ESD) procedures.The anesthetic method administered to cases undergoing upper gastrointestinal ESD between 2013 and 2015 was retrospectively investigated....

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Bibliographic Details
Published in:	Medicine (Baltimore) Vol. 95; no. 20; p. e3680
Main Authors:	Yurtlu, Derya Arslan, Aslan, Fatih, Ayvat, Pinar, Isik, Yasemin, Karakus, Nesli, Ünsal, Belkis, Kizilkaya, Mehmet
Format:	Journal Article
Language:	English
Published:	United States Wolters Kluwer Health, Inc. All rights reserved 01-05-2016 Wolters Kluwer Health
Subjects:	Adult Aged Aged, 80 and over Anesthesia, General - adverse effects Anesthetics, Intravenous - administration & dosage Anesthetics, Intravenous - adverse effects Arterial Pressure Conscious Sedation - adverse effects Dissection Endoscopy, Gastrointestinal - methods Female Fentanyl - administration & dosage Gastric Mucosa - surgery Gastrointestinal Neoplasms - surgery Heart Rate Humans Hypnotics and Sedatives - administration & dosage Hypnotics and Sedatives - adverse effects Intestinal Mucosa - surgery Male Midazolam - administration & dosage Middle Aged Observational Study Operative Time Postoperative Nausea and Vomiting - chemically induced Propofol - administration & dosage Propofol - adverse effects
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Summary:	The main objective of this study is to evaluate general anesthesia or propofol-based sedation methods at gastric endoscopic submucosal dissection (ESD) procedures.The anesthetic method administered to cases undergoing upper gastrointestinal ESD between 2013 and 2015 was retrospectively investigated. Procedure time, lesion size, dissection speed, anesthesia time, adverse effects such as gag reflex, nausea, vomiting, cough, number of desaturation episodes (SpO2 < 90%), oropharyngeal suctioning requirements, hemorrhage, perforation, and amount of anesthetic medications were recorded.There were 54 and 37 patients who were administered sedation (group S) and general anesthesia (group G), respectively. The demographics of the groups were similar. The calculated dissection speed was significantly high in group G (36.02 ± 20.96 mm/min) compared with group S (26.04 ± 17.56 mm/min; P = 0.010). The incidence of nausea, cough, number of oropharyngeal suctioning, and desaturation episodes were significantly high in group S compared with that in group G (P < 0.5). While there was no difference between the groups in terms of hemodynamic parameters, in group S the use of propofol and in group G the use of midazolam and fentanyl were significantly higher (P < 0.05). Anesthesia time, postoperative anesthesia care unit, and hospital stay durations were not significantly different between the groups.General anesthesia increased dissection speed and enhanced endoscopist performance when compared with propofol-based sedation technique.
ISSN:	0025-7974 1536-5964
DOI:	10.1097/MD.0000000000003680