Safety of continuous propofol sedation for endoscopic procedures in elderly patients

Abstract

Objective: to evaluate safety of continuous propofol sedation in elderly patients who undergo endoscopic procedures and investigate risk factors to develop complications in the geriatric population.Material and methods: patients who received endoscopistdirected propofol sedation were classified into two groups according to age. Group I: > 80 years; Group II: < 80 years. Propofol was administered by continuous intravenous infusion to achieve deep sedation. Arterial oxygen saturation, heart rate, blood pressure, and electrocardiographic records were monitored during the procedure. Therapy and complications secondary to sedation were recorded.Results: one thousand two-hundred and ninety-five endoscopic procedures (gastroscopies, colonoscopies and endoscopic ultrasonographies) were included. The dose of propofol was lower and therapy was more frequently performed in Group I. There were no differences between sedation-related complications in both groups (Group I: 15.4%; Group II: 14%; p, NS). Patients in Group I showed greater tendency to develop severe oxygen desaturation in the colonoscopy and endoscopic ultrasonography procedures. In the univariate analysis, a higher dose of propofol was associated with the appearance of complications (157.4 ± 84.4 vs. 121.3 ± 89.6 mg) in elderly patients but it was not associated with severe oxygen desaturation.Conclusions: continuous propofol sedation during endoscopic procedures in elderly patients > 80 years is as safe as in younger patients.

Intermittent boluses versus pump continuous infusion for endoscopist-directed propofol administration in colonoscopy

“…An initial bolus of propofol (dose adapted to patient weight, age or comorbidity) is administered intravenously, followed by repeated boli according to desired sedation depth and the patient condition. Scarce scientific evidence is available on NAAP using continuous infusion systems for colonoscopy so far now (6)(7)(8). According to our hypothesis, continuous infusion of propofol might exert a more sustained sedative effect by maintaining a preset concentration of propofol in the blood or brain, providing a higher patient satisfaction with the procedural sedation.…”

Performing colonoscopy in elderly and very elderly patients: Risks, costs and benefits

“…Nevertheless, when taken in context, the complication rate is still quite low even for patients over 85 years of age, and in most cases colonoscopy can be done safely with appropriate monitoring and precautions [20] . Furthermore, several studies have shown that propofol sedation, despite its propensity to lower blood pressure, can be used safely in elderly patients [21][22][23] . The overall major Lin OS.…”

Propofol versus midazolam in sedation for upper gastrointestinal endoscopy

“…Furthermore, Correia et al [21] reported results in concordance with results of the present work. Moreover, Martinez et al [22] reported that, continuous propofol sedation in geriatrics [patients >80 years] is generally as safe as in younger populations, although, geriatrics are more prone to complications. Singh et al [23] conducted a metaanalysis of 20 studies for sedation in cirrhotic patients and showed that, recovery time was shorter with propofol use than midazolam.…”