Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Department of Gastroenterology, Iwakuni Clinical Center, Iwakuni, Japan.
Gastrointest Endosc. 2020 Aug;92(2):301-307. doi: 10.1016/j.gie.2020.03.002. Epub 2020 Mar 8.
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.
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.
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.
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.
高龄是内镜逆行胰胆管造影术（ERCP）中接受异丙酚镇静时发生不良事件（AE）的重要危险因素。本研究旨在评估在接受 ERCP 时使用靶控输注（TCI）系统的非麻醉医师管理的异丙酚镇静（NAAP）的安全性和疗效在老年患者中。
本研究回顾性分析了 2014 年 1 月至 2016 年 10 月期间在岩国医疗中心接受 TCI 系统下 ERCP 异丙酚镇静的 482 例患者。患者根据年龄分为 3 组：A 组，<70 岁（n=130）；B 组，≥70 岁且<85 岁（n=224）；和 C 组，≥85 岁（n=125）。我们比较了 ERCP 期间的异丙酚剂量和 AE。
A 组的总输注剂量中位数和异丙酚的最小和最大靶血浓度分别为 336 毫克、2.2μg/mL 和 2.2μg/mL；B 组分别为 184 毫克、1.0μg/mL 和 1.4μg/mL；C 组分别为 99 毫克、0.6μg/mL 和 1.0μg/mL，年龄较大的组需要较低的剂量（P<.0001）。23 例（4.8%）出现低血压，各组间无显著差异（A 组，2.3%；B 组，6.3%；C 组，4.8%；P=0.24）。16 例（3.3%）出现低氧血症，各组间无显著差异（A 组，3.1%；B 组，4.9%；C 组，0.8%；P=0.17）。所有 AE 均立即得到解决，无手术被取消。
在 ERCP 中使用 TCI 系统进行的 NAAP 镇静在老年患者中可能是可以接受的，其异丙酚剂量低于年轻患者。
