在早期胃癌和食管癌的内镜黏膜下剥离术中，不插管使用依托咪酯为基础的监测麻醉护理的安全性和有效性。

Safety and effectiveness of propofol-based monitored anesthesia care without intubation during endoscopic submucosal dissection for early gastric and esophageal cancers.

机构信息

Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.

Departments of Anesthesiology and Critical Care Medicine, National Cancer Center Hospital, Tokyo, Japan.

出版信息

Dig Endosc. 2015 Sep;27(6):665-73. doi: 10.1111/den.12457. Epub 2015 Mar 10.

DOI:10.1111/den.12457

PMID:25652131

Abstract

BACKGROUND AND AIM

Endoscopic submucosal dissection (ESD) becomes more difficult with an increased risk of complications if patient sedation is insufficient. We assessed the safety and effectiveness of propofol-based monitored anesthesia care (MAC) without intubation during ESD for early esophageal cancer (EEC) or early gastric cancer (EGC) in the endoscopy room.

METHODS

We investigated 1013 consecutive patients with 1126 lesions who underwent ESD for EGC/EEC with either MAC or regular sedation by endoscopists (control group) between July 2010 and March 2013. Patient characteristics, endoscopic findings, technical results, body movement, oxygen saturation (SpO2 ), and drug dosages were then examined.

RESULTS

MAC was carried out in 137 EGC (16%) and 82 EEC patients (57%), whereas regular sedation was used in 731 EGC (84%) and 63 EEC patients (43%). MAC was conducted in 21% of all ESD procedures. In the MAC and control groups, body movement requiring a third person for control occurred in 30 (22%) and 533 (72%) cases during gastric ESD (P < 0.0001) and in 36 (44%) and 53 (84%) cases during esophageal ESD (P < 0.0001), respectively. The median minimum SpO2 was significantly lower in the MAC group than in the control group during both gastric and esophageal ESD (96% vs 98%, P < 0.0001; 96% vs 98%, P < 0.0004, respectively). MAC did not cause any adverse effects requiring prolongation of hospitalization.

CONCLUSIONS

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.

摘要

背景与目的

如果患者镇静不足，内镜黏膜下剥离术（ESD）的难度会增加，且并发症风险也会升高。我们评估了在胃镜室内对早期食管癌（EEC）或早期胃癌（EGC）患者行 ESD 时，采用异丙酚基础的无插管监测麻醉管理（MAC）的安全性和有效性。

方法

我们调查了 2010 年 7 月至 2013 年 3 月期间，1013 例连续接受 ESD 治疗的 EGC/EGC 患者，共 1126 处病灶。这些患者中，82 例 EEC 患者和 137 例 EGC 患者采用 MAC（观察组），731 例 EGC 患者和 63 例 EEC 患者采用常规镇静（对照组）。

结果

MAC 组中，82 例 EEC 患者和 137 例 EGC 患者采用 MAC，对照组中，731 例 EGC 患者和 63 例 EEC 患者采用常规镇静。MAC 用于所有 ESD 操作的 21%。在胃 ESD 过程中，观察组和对照组中，因躯体运动需要第三人协助控制的分别有 30 例（22%）和 533 例（72%）（P < 0.0001）；在食管 ESD 过程中，观察组和对照组中，因躯体运动需要第三人协助控制的分别有 36 例（44%）和 53 例（84%）（P < 0.0001）。在胃和食管 ESD 过程中，观察组的最低 SpO2 中位数明显低于对照组（96% vs 98%，P < 0.0001；96% vs 98%，P < 0.0004）。MAC 未引起任何需要延长住院时间的不良事件。