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

Figure 1 Changes in the relative rate of increase of the salivary amylase activity level compared with the control level, salivary amylase activity (IR, %), and the bispectral index around the 26 episodes of salivary amylase activity elevation in the H-group. The baseline level of sAMY significantly increased in association with an IR of > 100% at only 5 min, with a significant difference (IR immediately before elevation/IR at elevation of sAMY = 8.72 ± 173/958 ± 1391%, ^aP < 0.001). However, the release of gastric wall tension and/or pentazocine injection effectively 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, ^bP < 0.001). The bispectral indices in the patients undergoing ESD proved to be stable throughout the procedures (^cP = 0.272), even when the sAMY level was elevated in association with an IR of > 100%, i.e., when the patient received SE. All 14 patients responded with “I did not wake up at all” on the post-ESD questionnaire. The data are presented as the mean ± SD. ESD: Endoscopic submucosal dissection; DS: Deep sedation; sAMY: Salivary amylase activity; SE: Sympathetic excitement; H-sAMY: A high value of salivary amylase activity; L-sAMY: A low value of salivary amylase activity.