The Elderly Also Deserves to Undergo Therapeutic Endoscopy Safely under Sedation with Propofol by Gastroenterologists

As many therapeutic endoscopic procedures are invasive, time-consuming, and has the risk of complications, adequate sedation is mandatory for safe procedure. The methods of sedation are variable from weak sedation with small doses of narcotics to general anesthesia. For therapeutic endoscopic procedures, benzodiazepines or propofol with/without narcotics have been most commonly used for sedation. Although propofol is short and rapid acting, and not associated with higher risk of complications compared with benzodiazepines, the complications such as respiratory and/or circulatory distress may be higher in the elderly who are more vulnerable to deep sedation. And the sedation by gastroenterologists may have more complications by deep sedation than that by anesthesiologists because the gastroenterologists may not monitor the patients closely by the endoscopic procedure itself. The adverse events during therapeutic endoscopic procedures under sedation with propofol by gastroenterologists were compared between the younger and the elderly group over age of 75 years. Propofol was administered continuously to maintain the sedation, and the level of sedation was determined using the Ramsay sedation score. In the results, circulatory distress during procedures was not significantly different between two groups in terms of hypotension, desaturation, and bradycardia. The complications were managed by temporary discontinuation of propofol, and there were no delayed awakening or resedation after recovery. As the therapeutic endoscopies have been extended into more invasive procedures, adequate sedation has also been considered to be essential for safety as well as comfort of patients. Propofol has been increasingly used with the advantages of rapid action,