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


CONCLUSIONS
Under careful monitoring the use of propofol for sedation during ERCP is superior to midazolam/meperidine even in high-risk octogenarians.
Riphaus
Andrea
A
Department of Internal Medicine I (Gastroenterology and Interventional Endoscopy), Klinikum Hannover-Siloah, Teaching Hospital of the Hannover Medical School, Hannover, Germany.
Stergiou
Nikos
N
Wehrmann
Till
T
D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015897:Comorbidity; D016292:Procedural Sedation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D008614:Meperidine / Q000008:administration & dosage / Q000009:adverse effects; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects; D008991:Monitoring, Physiologic; D015742:Propofol / Q000009:adverse effects; D012307:Risk Factors; D012449:Safety; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D008614:Meperidine; D008874:Midazolam; D015742:Propofol