ED procedural sedation of elderly patients: is it safe?
OBJECTIVE
Emergency physicians routinely perform emergency department procedural sedation (EDPS), and its safety is well established. We are unaware of any published reports directly evaluating the safety of EDPS in older patients (≥65 years old). Many EDPS experts consider seniors to be at higher risk. The objective was to evaluate the complication rate of EDPS in elderly adults.


METHODS
This was a prospective, observational study of EDPS patients at least 65 years old, as compared with patients aged 18 to 49 and 50 to 64 years. Physicians were blind to the objectives of this research. The study protocol required an ED nurse trained in data collection to be present to record vital signs and assess for any prospectively defined complications. We used American Society of Anesthesiologists (ASA) physical status classification for systemic disease to evaluate and account for the comorbidities of patients. We used the Fisher exact test for the difference in proportions across age groups and analysis of variance for the differences in dosing across age and ASA categories.


RESULTS
During the 4-year study, we enrolled 50 patients at least 65 years old, 149 patients aged 50 to 64 years, and 665 patients aged 18 to 49 years. Adverse event rates were 8%, 5.4%, and 5.2%, respectively (P = .563). The at least 65 years age group represented a greater percentage of those with higher ASA scores (P < .001). The average total sedative dose in the at least 65 years group was significantly lower than the comparisons (P < .001).


CONCLUSIONS
This study demonstrated no statistically significant difference in complication rate for patients 65 years or older. There was a significant decrease in mean sedation dosing with increased age and ASA score.
Weaver
Christopher S
CS
Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. chsweave@iupui.edu
Terrell
Kevin M
KM
Bassett
Robert
R
Swiler
William
W
Sandford
Beth
B
Avery
Sara
S
Perkins
Anthony J
AJ
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D016292:Procedural Sedation / Q000009:adverse effects*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
D006993:Hypnotics and Sedatives; D009294:Narcotics; D015742:Propofol