Background and Aims

Advanced age is an important risk factor for adverse events (AEs) during propofol sedation for endoscopic procedures. This study aimed to evaluate the safety and efficacy of nonanesthesiologist-administered propofol (NAAP) sedation with a target-controlled infusion (TCI) system in elderly patients during ERCP.

Methods

This study retrospectively analyzed 482 patients who underwent ERCP under propofol sedation with a TCI system at Iwakuni Medical Center between January 2014 and October 2016. Patients were divided into 3 groups according to their age: group A, <70 years (n = 130); group B, ≥70 and <85 years (n = 224); and group C, ≥85 years (n = 125). We compared the propofol dose and AEs during ERCP.

Results

The median total infusion dose and minimum and maximum target blood concentrations of propofol were 336 mg, 2.2 μg/mL, and 2.2 μg/mL in group A; 184 mg, 1.0 μg/mL, and 1.4 μg/mL in group B; and 99 mg, .6 μg/mL, and 1.0 μg/mL in group C, respectively, with older groups requiring a lower dose (P < .0001). Hypotension was observed in 23 patients (4.8%), with no significant difference between groups (group A, 2.3%; group B, 6.3%; group C, 4.8%; P = .24). Hypoxemia was observed in 16 patients (3.3%), with no significant difference between groups (group A, 3.1%; group B, 4.9%; group C, .8%; P = .17). All AEs were immediately resolved, and no procedures were aborted.

Conclusions

NAAP sedation with a TCI system during ERCP may be acceptable in elderly patients with a lower dose of propofol than that used in younger patients.

中文翻译：

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在接受ERCP的老年患者中使用靶控输注泵进行丙泊酚镇静。

背景和目标

高龄是内窥镜手术中异丙酚镇静过程中不良事件（AEs）的重要危险因素。这项研究的目的是评估ERCP期间非麻醉医师使用靶控输注（TCI）系统进行丙泊酚（NAAP）镇静的安全性和有效性。

方法

本研究回顾性分析了2014年1月至2016年10月间在岩国医疗中心用TCI系统在丙泊酚镇静下接受ERCP的482例患者。根据年龄将患者分为三组：A组，<70岁（n = 130）；B组，≥70岁且<85岁（n = 224）；C组≥85岁（n = 125）。我们比较了ERCP期间丙泊酚的剂量和不良事件。

结果

A组中丙泊酚的总输注中位数剂量和最低和最高目标血药浓度分别为336 mg，2.2μg/ mL和2.2μg/ mL；B组分别为184 mg，1.0μg/ mL和1.4μg/ mL；C组分别为99 mg，0.6μg/ mL和1.0μg/ mL，老年组则需要较低的剂量（P  <.0001）。在23位患者中观察到低血压（4.8％），各组之间无显着差异（A组为2.3％； B组为6.3％； C组为4.8％；P  = 0.24）。在16例患者中观察到低氧血症（3.3％），各组之间无显着差异（A组为3.1％； B组为4.9％； C组为0.8％；P  = .17）。所有不良事件均得到立即解决，并且未中止任何手术。

结论

丙泊酚剂量低于年轻患者的丙泊酚剂量较低的老年患者，在接受ERCP期间使用TCI系统进行NAAP镇静是可以接受的。