Ishido Kenji, Tanabe Satoshi, Kitahara Gen, Furue Yasuaki, Wada Takuya, Watanabe Akinori, Matsuda Hiromi, Okamoto Hirotsugu, Kusano Chika
Department of Gastroenterology Kitasato University School of Medicine Kanagawa Japan.
Department of Gastroenterology Ebina General Hospital Kanagawa Japan.
DEN Open. 2024 Dec 21;5(1):e70045. doi: 10.1002/deo2.70045. eCollection 2025 Apr.
The efficacy and safety of a sedation regimen combining dexmedetomidine and midazolam during endoscopic submucosal dissection for upper gastrointestinal tumors remains unclear. In this study, we aimed to evaluate the efficacy and safety of this sedation regimen, where non-anesthesiologists performed sedation.
Sixty-eight patients who underwent endoscopic submucosal dissection for upper gastrointestinal tumors, sedated by non-anesthesiologists, were retrospectively evaluated. The sedation was performed by non-anesthesiologists as part of on-the-job training (OJT) under anesthesiologists' supervision. Each non-anesthesiologist received OJT at least thrice. Proficiency levels were assessed during the third OJT session. The target sedation depth was a Richmond Agitation-Sedation Scale of -2 to -4, with 2 L/min of oxygen delivered via a nasal cannula at sedation initiation. The treatment completion rates, which measured efficacy and safety, were assessed by the frequencies of respiratory depression, hypotension, and bradycardia.
The study included 14, 52, and two patients with superficial esophageal cancer, early gastric cancer, and gastric adenoma, respectively. The median treatment time was 68 and 84 min for superficial esophageal cancer, early gastric cancer, and adenoma, respectively. Endoscopic submucosal dissection was completed in all patients. No severe sedation-related adverse events were reported; however, peripheral arterial oxygen saturation <90%, hypotension, and bradycardia occurred in 1 (1.5%), 30 (44.1%), and 30 patients (44.1%), respectively. All 22 non-anesthesiologists who underwent the proficiency evaluation passed the test.
A sedation regimen combining dexmedetomidine and midazolam can be feasibly administered by non-anesthesiologists. Further studies are needed to verify the effectiveness of OJT.
右美托咪定与咪达唑仑联合镇静方案用于上消化道肿瘤内镜黏膜下剥离术的有效性和安全性尚不清楚。在本研究中，我们旨在评估由非麻醉医生实施该镇静方案的有效性和安全性。
回顾性评估68例接受上消化道肿瘤内镜黏膜下剥离术且由非麻醉医生进行镇静的患者。作为在职培训（OJT）的一部分，非麻醉医生在麻醉医生的监督下实施镇静。每位非麻醉医生至少接受三次在职培训。在第三次在职培训期间评估熟练程度。目标镇静深度为里士满躁动镇静量表评分-2至-4，镇静开始时通过鼻导管以2L/min的流量输送氧气。通过呼吸抑制、低血压和心动过缓的发生频率评估衡量有效性和安全性的治疗完成率。
该研究分别纳入了14例、52例和2例浅表食管癌、早期胃癌和胃腺瘤患者。浅表食管癌、早期胃癌和腺瘤的中位治疗时间分别为68分钟和84分钟。所有患者均完成了内镜黏膜下剥离术。未报告严重的镇静相关不良事件；然而，外周动脉血氧饱和度<90%、低血压和心动过缓分别发生在1例（1.5%）、30例（44.1%）和30例（44.1%）患者中。所有接受熟练程度评估的22名非麻醉医生均通过了测试。
右美托咪定与咪达唑仑联合镇静方案可由非麻醉医生切实可行地实施。需要进一步研究以验证在职培训的有效性。
