Stepwise sedation for elderly patients with mild/moderate COPD during upper gastrointestinal endoscopy.
OBJECTIVE
To investigate stepwise sedation for elderly patients with mild/moderate chronic obstructive pulmonary disease (COPD) during upper gastrointestinal (GI) endoscopy.


METHODS
Eighty-six elderly patients with mild/moderate COPD and 82 elderly patients without COPD scheduled for upper GI endoscopy were randomly assigned to receive one of the following two sedation methods: stepwise sedation involving three-stage administration of propofol combined with midazolam [COPD with stepwise sedation (group Cs), and non-COPD with stepwise sedation (group Ns)] or continuous sedation involving continuous administration of propofol combined with midazolam [COPD with continuous sedation (group Cc), and non-COPD with continuous sedation (group Nc)]. Saturation of peripheral oxygen (SpO2), blood pressure, and pulse rate were monitored, and patient discomfort, adverse events, drugs dosage, and recovery time were recorded.


RESULTS
All endoscopies were completed successfully. The occurrences of hypoxemia in groups Cs, Cc, Ns, and Nc were 4 (9.3%), 12 (27.9%), 3 (7.3%), and 5 (12.2%), respectively. The occurrence of hypoxemia in group Cs was significantly lower than that in group Cc (P < 0.05). The average decreases in value of SpO2, systolic blood pressure, and diastolic blood pressure in group Cs were significantly lower than those in group Cc. Additionally, propofol dosage and overall rate of adverse events in group Cs were lower than those in group Cc. Finally, the recovery time in group Cs was significantly shorter than that in group Cc, and that in group Ns was significantly shorter than that in group Nc (P < 0.001).


CONCLUSIONS
The stepwise sedation method is effective and safer than the continuous sedation method for elderly patients with mild/moderate COPD during upper GI endoscopy.
Department of Gastroenterology, Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China. xucanxia2000@hotmail.com
Can-Xia
CX
Xu
Xiong
X
Chen
Yan
Y
Jia
Ding-Hua
DH
Xiao
Hui-Fang
HF
Zou
Qin
Q
Guo
Fen
F
Wang
Xiao-Yan
XY
Wang
Shou-Rong
SR
Shen
Ling-Ling
LL
Tong
Ke
K
Cao
Xiao-Ming
XM
Liu
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D016009:Chi-Square Distribution; D002681:China; D004334:Drug Administration Schedule; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007022:Hypotension / Q000209:etiology / Q000503:physiopathology; D000860:Hypoxia / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008874:Midazolam / Q000008:administration & dosage* / Q000009:adverse effects; D010100:Oxygen / Q000097:blood; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000503:physiopathology; D012307:Risk Factors; D012720:Severity of Illness Index
D015415:Biomarkers; D006993:Hypnotics and Sedatives; D008874:Midazolam; D010100:Oxygen; D015742:Propofol
Adverse events; Chronic obstructive pulmonary disease; Monitoring; Sedation; Upper gastrointestinal endoscopy