title: Propofol sedation with a target-controlled infusion pump and bispectral index monitoring system in elderly patients during a complex upper endoscopy procedure.
abstract: OBJECTIVE
  Although the usefulness of propofol sedation during endoscopic submucosal dissection (ESD) for gastric neoplasms was reported previously, information is limited on its use in elderly patients. We investigated the safety and efficacy of propofol sedation with a target-controlled infusion (TCI) pump and bispectral index (BIS) monitoring system (TCI/BIS system) in elderly patients during gastric ESD.
  
  
  METHODS
  Included were 413 consecutive gastric ESD procedures involving 455 lesions (379 patients) performed in patients under propofol sedation with a TCI/BIS system between October 2009 and September 2013. Patients were divided into 3 groups: group A, age <70 years (n = 162); group B, age ≥70 and <80 years (n = 171); and group C, age ≥80 years (n = 80). We compared the propofol dose and adverse events (eg, hypotension and hypoxemia) during ESD.
  
  
  RESULTS
  Older groups required a lower target concentration of propofol (group A: median 2.1 μg/mL [interquartile range (IQR), 1.9-2.3]; group B: median 1.6 μg/mL [IQR, 1.3-1.8]; and group C: median 1.4 μg/mL [IQR, 1.2-1.6]; P < .0001). Hypotension tended to occur in the younger group, and hypoxemia occurred at a significantly higher rate in the older groups, although the number of cases was small. Low preoperative systolic blood pressure (≤125 mm Hg) was associated with hypotension (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.12-2.70; P = .013) and abnormal pulmonary function was associated with hypoxemia in groups B and C (OR, 4.54; 95% CI, 1.01-31.5; P = .048).
  
  
  CONCLUSIONS
  Elderly patients required lower doses of propofol with the TCI/BIS system than younger patients. Attention to hypoxemia is necessary in elderly patients, particularly patients with abnormal pulmonary function.
authors: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
authors: Tatsuhiro
authors: T
authors: Gotoda
authors: Department of Endoscopy, Okayama University Hospital, Okayama, Japan.
authors: Hiroyuki
authors: H
authors: Okada
authors: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
authors: Keisuke
authors: K
authors: Hori
authors: Department of Endoscopy, Okayama University Hospital, Okayama, Japan.
authors: Yoshiro
authors: Y
authors: Kawahara
authors: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
authors: Masaya
authors: M
authors: Iwamuro
authors: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
authors: Makoto
authors: M
authors: Abe
authors: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
authors: Yoshiyasu
authors: Y
authors: Kono
authors: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
authors: Kou
authors: K
authors: Miura
authors: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
authors: Hiromitsu
authors: H
authors: Kanzaki
authors: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
authors: Masahide
authors: M
authors: Kita
authors: Department of Endoscopy, Okayama University Hospital, Okayama, Japan.
authors: Seiji
authors: S
authors: Kawano
authors: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
authors: Kazuhide
authors: K
authors: Yamamoto
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D054810:Deep Sedation / Q000009:adverse effects / Q000295:instrumentation; D004210:Dissection; D016903:Drug Monitoring / Q000295:instrumentation; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D007022:Hypotension / Q000139:chemically induced; D000860:Hypoxia / Q000139:chemically induced; D007260:Infusion Pumps; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D013274:Stomach Neoplasms / Q000601:surgery*; D013599:Systole
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol