SUCCESSFUL ENDOSCOPIC SUBMUCOSAL DISSECTION USING DEXMEDETOMIDINE FOR SEDATION IN A PATIENT WITH MYASTHENIA GRAVIS: A CASE REPORT

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  • KUROKI Daisuke
    Department of Gastroenterology and Hepatology, University of Miyazaki Hospital.
  • KAWAKAMI Hiroshi
    Department of Gastroenterology and Hepatology, University of Miyazaki Hospital. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine
  • NAKASHIMA Kouji
    Department of Gastroenterology and Hepatology, University of Miyazaki Hospital. Department of Medical Oncology, University of Miyazaki Hospital.
  • SUZUKI Sho
    Department of Gastroenterology and Hepatology, University of Miyazaki Hospital.
  • MIIKE Tadashi
    Department of Gastroenterology and Hepatology, University of Miyazaki Hospital.
  • ASHIZUKA Shinya
    Department of Gastroenterology and Hepatology, University of Miyazaki Hospital.
  • ABE Hiroo
    Department of Gastroenterology and Hepatology, University of Miyazaki Hospital.
  • YAMAMOTO Shojiro
    Department of Gastroenterology and Hepatology, University of Miyazaki Hospital.
  • INATSU Haruhiko
    Department of Gastroenterology and Hepatology, University of Miyazaki Hospital.
  • HOSOKAWA Ayumu
    Department of Medical Oncology, University of Miyazaki Hospital.

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Other Title
  • デクスメデトミジンによる鎮静でESDを安全に施行し得た重症筋無力症患者の１例

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<p>A 37-year-old man underwent thymectomy for myasthenia gravis and subsequently received oral medication. Screening upper gastrointestinal endoscopy revealed a 20mm fading concave lesion on the posterior wall of the greater curvature of the stomach. He was diagnosed with signet-ring cell carcinoma based on histopathological examination of a biopsy specimen and was referred to our hospital for further management. Preoperative evaluation led to a diagnosis of early gastric cancer and he was scheduled for endoscopic submucosal dissection (ESD). Benzodiazepines are contraindicated for sedation in patients with myasthenia gravis, and a drug that does not cause muscle relaxation should be administered. Therefore, in this patient, we performed successful ESD using a combination of dexmedetomidine, pentazocine, and hydroxyzine for sedation. Dexmedetomidine is useful for limited sedation that is required during endoscopic procedures in patients with myasthenia gravis.</p>

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