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1.
BMC Gastroenterol ; 17(1): 127, 2017 Nov 28.
Article in English | MEDLINE | ID: mdl-29179691

ABSTRACT

BACKGROUND: The present study was performed to compare the safety of sedation during endoscopic submucosal dissection (ESD) in the endoscopy room versus operation room. METHODS: In total, 297 patients with gastrointestinal tumors who underwent ESD from January 2011 to December 2016 were retrospectively reviewed. The patients were divided into two groups: those who underwent ESD in the endoscopy room without propofol (Group E) versus operation room with propofol (Group O). The patient, tumor, and procedure characteristics; adverse events; and treatment outcomes were compared between the two groups. RESULTS: The patient and tumor characteristics, including age (73.6 ± 8.2 vs. 72.5 ± 9.1 years), comorbidities, and tumor size and histology, were not different between Groups E and O. The ESD procedure time was comparable between Groups E and O (105.4 ± 70.4 vs. 106.5 ± 64.4 min), and the anesthesia time was equivalent (138.3 ± 78.1 vs. 148.4 ± 68.8 min). There were no significant differences in adverse events between the two groups. During the ESD procedure, desaturation occurred significantly more often in Group E than O (12.9% vs. 4.0%, P = 0.021, odds ratio: 3.53, 95% CI: 1.17-14.4). The recovery time after ESD was significantly longer in Group E than O (180 (100-360) vs. 90 (0-180) min, P < 0.001). CONCLUSIONS: A decreased desaturation rate and shorter recovery time after ESD were the advantages of sedation in the operation room with propofol compared with sedation in the endoscopy room. These findings warrant further exploration of the advantages of safe and effective ESD for upper gastrointestinal neoplasms in the operation room.


Subject(s)
Analgesics, Opioid/administration & dosage , Benzodiazepines/administration & dosage , Endoscopic Mucosal Resection , Gastrointestinal Neoplasms/surgery , Hypnotics and Sedatives/administration & dosage , Propofol/administration & dosage , Upper Gastrointestinal Tract/surgery , Aged , Analgesics, Opioid/adverse effects , Anesthesia Recovery Period , Benzodiazepines/adverse effects , Hospital Units , Humans , Hypnotics and Sedatives/adverse effects , Operating Rooms , Propofol/adverse effects , Retrospective Studies
2.
Masui ; 61(2): 138-42, 2012 Feb.
Article in Japanese | MEDLINE | ID: mdl-22413434

ABSTRACT

BACKGROUND: In surgical graft replacement of the descending aorta graft, one-lung ventilation (OLV) is required to provide adequate surgical view and to allow removal of blood from the left lung. It is best to use a double-lumen tube (DLT) to assure OLV but it is sometimes difficult to place the left-sided DLT due to thoracic aneurysm or the dissection lumen. We retrospectively investigated tracheobronchial anatomy by chest X-ray and chest computed tomography (CT) in 29 cases of descending aorta replacement to determine how best to manage difficult placement of the left-sided DLT. METHODS: From our database of 29 patients who had undergone descending aorta replacement between February 1, 2005, and December 31, 2009, we investigated the association between difficulty in placing the left-sided DLT and tracheobronchial anatomy by chest X-ray and CT. RESULTS: We could not place a left-sided DLT in 3 of 29 cases. Two of these cases were planned surgery for aortic aneurysm and the other was an emergency operation for acute aortic dissection. We could manage the two cases safely using a right-sided DLT. We compared chest X-ray and chest CT images of these 3 cases with the other 26 cases and found that compression of the tracheobronchial tree was prevalent in the cases of difficult placement of the left-sided DLT. CONCLUSIONS: We experienced difficulty in placement of the left-sided DLT in 3 of 29 cases of descending aorta replacement. We can predict difficulty of left-sided DLT placement by the presence of compression of the tracheobronchial tree on chest CT.


Subject(s)
Aorta, Thoracic/surgery , Blood Vessel Prosthesis Implantation , Bronchi/pathology , Intubation, Intratracheal/methods , Trachea/pathology , Aged , Aortic Dissection/surgery , Aortic Aneurysm/surgery , Bronchi/anatomy & histology , Bronchography , Female , Humans , Male , Middle Aged , Tomography, X-Ray Computed , Trachea/anatomy & histology , Trachea/diagnostic imaging
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