Anesth Pain Med.  2017 Oct;12(4):402-407. 10.17085/apm.2017.12.4.402.

Severe respiratory depression precipitated by unrecognized gastric perforation during endoscopic submucosal dissection under deep sedation: A case report

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jiwon0715.choi@samsung.com

Abstract

Endoscopic submucosal dissection (ESD) is widely performed these days as the standard procedure for the treatment of early gastric cancer. During ESD, insertion and rotation of the scope, air insufflation, incision and hemostasis may provoke pain, which commonly requires either general anesthesia or moderate to deep sedation. Deep sedation precludes the need for general anesthesia, and can help endoscopists speed up the procedure compared to light sedation. But, there are risks of respiratory complication. We report a case of respiratory compromise caused by pneumoperitoneum from unrecognized gastric perforation during ESD under deep sedation.

Keyword

Deep sedation; Endoscopic submucosal dissection; Pneumoperitoneum; Respiratory depression

MeSH Terms

Anesthesia, General
Deep Sedation*
Hemostasis
Insufflation
Pneumoperitoneum
Respiratory Insufficiency*
Stomach Neoplasms

Figure

  • Fig. 1 Endogastroduodenoscopic view of a hemostatic clipping of the bleeder site in the submucosa of the stomach during endoscopic submucosal dissection procedure.

  • Fig. 2 Chest radiograph on the day of endoscopic submucosal dissection. Pneumoperitoneum is markedly increased compared to the preoperative chest radiograph. The arrows indicates free air (A). Chest radiograph on the postoperative 5 days delineates a remaining pneumoperitoneum and subcutaneous emphysema, but without clinical significance (B).


Reference

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