Propofol Sedation for Endoscopic Procedures in Patients 90 Years of Age and Older

Abstract

Background and Aim: There are only a few studies on propofol sedation for very elderly patients. The present study was undertaken to evaluate the safety of propofol sedation in patients 90 years of age and older undergoing endoscopic procedures. Methods: We prospectively assessed endoscopic procedures for patients 90 years of age and older using propofol sedation. Endoscopic procedures, dosage used, respiratory depression, complications and 30-day mortality were evaluated. In a subset of the enrolled patients, the blood concentrations of propofol were measured. Results: All 241 patients completed endoscopic procedures. For esophagogastroduodenoscopy, percutaneous endoscopic gastrostomy, colonoscopy, and endoscopic retrograde cholangiopancreatography, the mean propofol doses used were 22, 24, 46 and 42 mg, respectively. Four patients required oxygen and 1 patient was treated by short periods of mask ventilation. There was no perforation, bleeding, pancreatitis or 30-day mortality. In diagnostic esophagogastroduodenoscopy, the level of sedation and propofol blood concentrations after administration of propofol (24 ± 6.8 mg) in patients 90 years of age and older corresponded to those of propofol (61 ± 13 mg) in middle-aged patients (control). Conclusion: Low-dose propofol sedation is safe and may be enough for patients 90 years of age and older undergoing endoscopic procedures.

Safety of continuous propofol sedation for endoscopic procedures in elderly patients

“…Age and severe complications were not related when the patient underwent gastroscopy + colonoscopy despite the doses of propofol It could be argued that complication rate in patients ≥ 80 years is not higher than in younger patients because the dose of propofol was significantly lower in those patients. This fact is shared by several studies comparing elderly and young people (7,20,27,28,35,36). This hypothesis is supported by the fact that, as we have observed, dose increase is the only risk factor to develop complications in patients ≥ 80 years.…”

“…We used the required dose to achieve deep sedation (MOAA/S score of 1) and elderly patients achieved deep sedation with a lower dose. In fact, it has been proved that elderly patients require a lower dose of propofol to reach similar plasmatic levels to younger people (20,36). The absence of differences regarding the development of sedation-related complications might be explained by the fact that we selected a healthy subgroup of octogenarians.…”

“…These patients are highly susceptible to hypoventilation and apnea due to changes in the pharmacokinetic and the pharmacodynamic profile. Thus, it has been proved that patients > 90 years present similar plasma propofol levels to younger controls although dose in older patients was 40% lower (18,20). Though this group of patients shows better tolerance to endoscopic procedures without sedation (18,21), several studies suggest that conscious and deep sedation are safe (5,18,(22)(23)(24)(25)(26).…”

Safety and Utility of Endoscopic Removal of Common Bile Duct Stones in the Elderly

“…It has been reported that low-dose propofol provides stable sedation for ERCP in patients ≥ 90 years of age 14 . A previous study performed in patients aged between 23 and 94 years reported an incidence of cardiopulmonary complications following ERCP of 4.1% in those aged 80 years, compared with 7.1% in those aged ≥ 80 years 15 .…”

Effectiveness of outpatient percutaneous endoscopic gastrostomy replacement using esophagogastroduodenoscopy and propofol sedation

“…Propofol is a good sedative agent for endoscopic procedures, in that it is superior to benzodiazepines with regard to rapidity of induction of sedation and is associated with a faster recovery [3][4][5][6] . Propofol sedation in high risk and elderly patients undergoing endoscopic procedures has been reported to be both safe and effective [7][8][9][10][11][12][13][14][15] . The aim of this study was to evaluate the effectiveness of PEG replacement using EGD and low-dose propofol sedation in the outpatient setting.…”