Sedation with propofol for routine ERCP in high-risk octogenarians: a randomized, controlled study.

Abstract

OBJECTIVES:

Adequate patient sedation is mandatory for diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). In this respect it is known that the short-acting anesthetic propofol offers certain potential advantages for sedation during ERCP, but there are no controlled studies concerning the feasibility and safety of propofol sedation in elderly, high-risk patients.

METHODS:

One hundred and fifty consecutive patients aged >or=80 yr with high comorbidity (ASA score >or=III: 91 %), randomly received midazolam plus meperidine (n = 75) or propofol alone (n = 75) for sedation during ERCP. Vital signs were continuously monitored and procedure-related parameters, recovery time, and quality as well as patients' cooperation and tolerance of the procedure were assessed.

RESULTS:

Clinically relevant changes in vital signs were observed at comparable frequencies with a temporary oxygen desaturation (<90%) occurring in eight patients in the propofol-group and seven patients receiving midazolam/meperidine (n.s.). Hypotension was documented in two patients in the propofol group and one patient receiving midazolam/meperidine. Propofol provided a significantly better patient cooperation than midazolam/meperidine (p < 0.01), but the procedure tolerability was rated nearly the same by both groups. Mean recovery time was significantly shorter in the propofol group (22 +/- 7 min vs 31 +/- 8 min for midazolam/meperidine (p < 0.01)) while the recovery score was significantly higher under propofol (8.3 +/- 1.2 vs 6.1 +/- 1.1(p < 0.01)). During recovery a significant lower number of desaturation events (<90%) were observed in the propofol group (12%) than in the midazolam/meperidine group (26%, p < 0.01).

CONCLUSION:

Under careful monitoring the use of propofol for sedation during ERCP is superior to midazolam/meperidine even in high-risk octogenarians.

• Authors: Andrea Riphaus, Nikos Stergiou, Till Wehrmann
• Journal: The American journal of gastroenterology (Am J Gastroenterol) Vol. 100 Issue 9 Pg. 1957-63 (Sep 2005) ISSN: 0002-9270 [Print] United States
• PMID: 16128939 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Hypnotics and Sedatives
• Meperidine
• Midazolam
• Propofol

Topics

• Aged
• Cholangiopancreatography, Endoscopic Retrograde
• Comorbidity
• Conscious Sedation (methods)
• Feasibility Studies
• Female
• Follow-Up Studies
• Humans
• Hypnotics and Sedatives (adverse effects)
• Hypotension (chemically induced)
• Male
• Meperidine (administration & dosage, adverse effects)
• Midazolam (administration & dosage, adverse effects)
• Monitoring, Physiologic
• Propofol (adverse effects)
• Risk Factors
• Safety
• Treatment Outcome