Gotoda Takuji, Kusano Chika, Nonaka Masaya, Fukuzawa Masakatsu, Kono Shin, Suzuki Sho, Sato Takemasa, Tsuji Yuichiro, Itoi Takao, Moriyasu Fuminori
Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan,
Gastric Cancer. 2014 Oct;17(4):686-91. doi: 10.1007/s10120-013-0336-9. Epub 2014 Jan 8.
Propofol is rapidly increasing in use in many countries because endoscopists and patients report greater satisfaction with propofol than with conventional sedatives. However, propofol infusion during lengthy endoscopic procedures in elderly patients is still controversial. We investigated the safety of gastroenterologist-guided propofol sedation in elderly patients who underwent gastric endoscopic submucosal dissection (ESD) at a single center.
We reviewed 121 medical records of patients who underwent gastric ESD. We compared retrospectively the details of propofol usage, hemodynamics, and re-sedation in the elderly group to those in a younger group.
No significant differences in patients' baseline characteristic including ASA classification between elderly and younger groups were shown. The average maintenance dose and total dose of propofol infusion could be similarly administrated in both groups. Seven adverse events (5.8 %) occurred at the time of propofol bolus injection. Although 3 cases (2.5 %) of hypotension (systolic blood pressure <80 mmHg), 8 cases (6.6 %) of desaturation (blood oxygen saturation <90 %) and 1 case (0.8 %) of bradycardia (pulse rate <40) were found during the maintenance of propofol infusion, there were no statistically significant differences in the elderly and younger groups. All events were immediately resolved without any intervention. No patients developed a re-sedated condition.
Gastroenterologist-guided propofol sedation during gastric ESD may be acceptable even in the elderly with ASA classification I/II under careful monitoring of vital signs and oxygen saturation.
在许多国家，丙泊酚的使用正在迅速增加，因为内镜医师和患者报告称，与传统镇静剂相比，他们对丙泊酚的满意度更高。然而，在老年患者的长时间内镜手术中使用丙泊酚仍存在争议。我们在一个中心调查了在胃肠病学家指导下对接受胃内镜黏膜下剥离术（ESD）的老年患者使用丙泊酚镇静的安全性。
我们回顾了121例接受胃ESD患者的病历。我们回顾性比较了老年组和年轻组丙泊酚使用细节、血流动力学和再次镇静情况。
老年组和年轻组在包括ASA分级在内的患者基线特征方面未显示出显著差异。两组丙泊酚输注的平均维持剂量和总剂量可以相似地给药。在丙泊酚推注时发生了7例不良事件（5.8%）。虽然在丙泊酚输注维持期间发现3例（2.5%）低血压（收缩压<80 mmHg）、8例（6.6%）血氧饱和度降低（血氧饱和度<90%）和1例（0.8%）心动过缓（心率<40），但老年组和年轻组之间无统计学显著差异。所有事件在未进行任何干预的情况下立即得到解决。没有患者出现再次镇静的情况。
在生命体征和血氧饱和度的仔细监测下，即使是ASA分级为I/II的老年患者，在胃ESD期间由胃肠病学家指导的丙泊酚镇静可能也是可以接受的。
