Non-anesthesiologist administrated propofol (NAAP) during endoscopic submucosal dissection for elderly patients with early gastric cancer.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.