Propofol sedation with a target-controlled infusion pump in elderly patients undergoing ERCP

Background and Aims: 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. Methods: 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. Results: 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. Conclusions: 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.