Monitoring salivary amylase activity is useful for providing timely analgesia under sedation

AIM:To detect the criteria and cause of elevated salivary amylase activity(sAMY)in patients undergoing endoscopic submucosal dissection(ESD)under sedation.METHODS:A total of 41 patients with early gastric cancer removed via ESD under deep sedation(DS)were enrolled.The perioperative sAMY,which was shown as sympathetic excitements(SE),was measured.The time at which a patient exhibited a relatively increased rate of sAMY compared with the preoperative baseline level(IR,%)≥100%(twice the actual value)was assumed as the moment when the patient received SE.Among the 41 patients,we focused on 14 patients who exhibited an IR≥100% at any time that was associated with sAMY elevation during ESD(H-group)and examined whether any particular endoscopic procedures can cause SE by simultaneously monitoring the sAMY level.If a patient demonstrated an elevated sAMY level above twice the baseline level,the endoscopic procedure was immediately stopped.In the impossible case of discontinuance,analgesic medicines were administered.This study was performed prospectively.RESULTS:A total of 26 episodes of sAMY eruption were considered moments of SE in the H-group.The baseline level of sAMY significantly increased in association with an IR of>100% at 5 min,with a significant difference(IR immediately before elevation/IR at elevation of sAMY=8.72±173/958±1391%,P<0.001).However,effective intervention decreased the elevated sAMY level immediately within only 5 min,with a significant difference(IR at sAMY elevation/immediately after intervention=958±1391/476±1031,P<0.001).The bispectral indices,systolic blood pressure and pulse rates,which were measured at the same time,remained stable throughout the ESD.Forceful endoscopic insertion or over insufflation was performed during 22 of the 26 episodes.Release of the gastric wall tension and/or the administration of analgesic medication resulted in the immediate recovery of the elevated sAMY level,independent of body movement.CONCLUSION:By detecting twice the actual sAMY based on the preoperative level,the release of the gastric wall tension or the administration of analgesic agents should be considered.

Usefulness of a Newly-Developed Device, the Power Tree^(■), for Body Massage: Evidence from a Medical Evaluation

We investigated the effectiveness and usefulness of a novel tool: the Power Tree?, for body massage in 10 healthy female volunteers (age range, 24 - 55 years;mean age, 40.5 years) by evaluating several dermatological and psychological parameters, such as the amount of dermal collagen, the skin temperature, the level of salivary amylase and the scores on the State-Trait Anxiety Index (STAI). After 60-minute Power Tree?-mediated body massage, both the dermal collagen score determined from the DermaLab? images and skin temperature measured by infrared thermography were found to have increased significantly in several body sites compared to those before the treatment (p < 0.01 and p < 0.001, respectively). Although the level of stress estimated by the amount of amylase in the saliva was not significantly different pre- and post-procedure (p = 0.3), the treatment significantly reduced both the state anxiety (SA) and trait anxiety (TA) scores on the STAI (p < 0.001 for the SA, p < 0.01 for the TA). The treatment with this device was smoothly performed without any burden on the therapists during the present study. These data suggest that the newly-developed device is a powerful and useful tool for reflexology when used for full body massage therapy, and massage therapy using this device may produce beneficial, physiological effects as well as psychosocial improvements.