Keisuke Hori, MD, PhD, from the Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, in Okayama, Japan discusses this Original Article, “Propofol sedation with a target-controlled infusion pump and bispectral index monitoring system in elderly patients during a complex upper endoscopy procedure.”

The focus of our study was to investigate the safety and efficacy of propofol sedation with a target controlled infusion (TCI) pump and bispectral index (BIS) monitoring system (TCI/BIS system) in elderly patients during gastric endoscopic submucosal dissection (ESD). Elderly patients required lower doses and target concentration of propofol with the TCI/BIS system than younger patients.

Hypotension tended to occur at a higher ratio in the younger groups, but the difference was not significant. Hypoxemia occurred at a significantly higher ratio in the older group but the prevalence was low. Almost all events resolved immediately after decreasing the amount dosage of propofol and increasing the per-nasal oxygen dosage.

Figure 2. Correlation between age and the target blood concentration. There was a moderate inverse correlation between age and the target blood concentration (A, B, C). The older age groups needed a lower target blood concentration (D, E, F). Age groups: group A, age <70 years (n Z 162); group B, age 70 and <80 years (n Z 171); and group C, age 80 years (n Z 80).

This study was important in order to assess the usefulness of propofol sedation during complex endoscopic procedures such as ESD for gastric neoplasms in elderly patients. When treating older patients, special attention is necessary to avoid sedation-related adverse events because elderly individuals generally have one or more underlying diseases. The TCI/BIS system for such endoscopic treatment are thought to be useful.

Our study revealed that propofol sedation with a TCI/BIS system is very effective in performing ESD in elderly persons safely with a lower dose of propofol. Further studies on a larger scale with a prospective controlled design are needed to standardize sedation with propofol.

Read the abstract online here.

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