Sedation Induced by Dexmedetomidine Hydrochloride Is Applicable for Endoscopic Submucosal Dissection of Esophageal and Gastric Upper Tumors: A Pilot Trial in Saga Medical School Hospital

Abstract

Introduction: Endoscopic submucosal dissection (ESD) has been applied for treatment for esophageal and gastric cancers. ESD, minimally invasive treatment compared to laparotomy, requires much operation time and pain of the patient, and sedation for ESD is the essential procedure. Midazolam (MDZ) was mainly applied for sedation during ESD in our hospital, and this study aimed to examine if dexmedetomidine hydrochloride (DEX) was applicable for sedation during ESD of esophageal and gastric cancers compared to MDZ. Methods: All the 40 patients with esophageal or gastric cancers treated by ESD were divided into two groups (DEX group and MDZ group) in the present study. Patients of the DEX groups (n = 20) was injected intravenously for 10 min at 4˜6 μg/kg/h with 7.5 mg pentazocine during introduction of sedation followed by maintenance dose of 0.4 μg/kg/h of DEX. Patients of the MDZ group (n = 20) was injected intravenously at 1 min at 0.1 mg/kg with 7.5 mg pentazocine for introduction and 1 mg/kg for maintenance. Blood pressure, heart rate, oxygen saturation, and sedation level were monitored during ESD. Richmond Agitation-Sedation Scale (RASS) was used for measurement of the sedation level of the patients. Results: Serious complication of ESD including perforation and bleeding was not observed in the both groups (0% in each). Reduction of the level of oxygen saturation to ≤90% was significantly more frequency MDZ group (45%) than DEX group (5%: p < 0.05). The mean of the RASS score in the MDZ group was 1, which was significantly high compared to that in the DEX group (-3: p < 0.05). The level of oxygen saturation and RASS score were stable in the DEX group compared to the MDZ group, suggesting that DEX introduced effective sedation and respiratory care. Conclusion: This pilot trial suggested that sedation with DEX might be effective and safe during ESD for esophageal and gastric tumors, which warrant further exploration including randomized trial with a large number of patients.