Efficacy of midazolam- versus propofol-based sedations by non-anesthesiologists during therapeutic endoscopic retrograde cholangiopancreatography in patients aged over 80 years.
OBJECTIVE
As society ages, the need for endoscopic retrograde cholangiopancreatography (ERCP) is increasing. This prospective comparative study evaluated the safety and efficacy of midazolam- versus propofol-based sedations by non-anesthesiologists during therapeutic ERCP in patients over 80 years of age.


METHODS
A total of 100 patients over 80 years of age who required therapeutic ERCP were enrolled and randomly received midazolam + fentanyl (MF group) or propofol + fentanyl (PF group) sedation. Endoscopic sedation was titrated to a moderate level and carried out by trained registered nurses. Main outcome measurements were sedation safety in terms of cardiopulmonary components and efficacy measured on a 10-point visual analogue scale (VAS).


RESULTS
Regarding safety, hypoxia occurred in seven (14%) in the MF group and in eight patients (16%) in the PF group (P = 0.779). Increased O2supply was more frequent in the PF group (32% vs 42%), albeit not significantly so. There were no differences in the frequency of hypotension, bradycardia or tachycardia between the two groups. Mean VAS score for overall satisfaction with sedation by patients, endoscopists, and nurses and the scores for pain during the procedures were not different between the two groups. There was no significant difference in the procedure outcomes or rate of ERCP-related complications.


CONCLUSIONS
There were no significant differences of safety and efficacy between midazolam- and propofol-based sedation in patients over 80 years of age. Increased O2supply was more frequent in the propofol group, but the prevalence of hypoxia did not differ significantly.
Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea.
Su Jung
SJ
Han
Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea.
Tae Hoon
http://orcid.org/0000-0002-9615-0761
TH
Lee
Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea.
Sang-Heum
SH
Park
Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea.
Young Sin
YS
Cho
Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, South Korea.
Yun Nah
YN
Lee
Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea.
Yunho
Y
Jung
Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, South Korea.
Hyun Jong
HJ
Choi
Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea.
Il-Kwun
IK
Chung
Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Seoul, Korea.
Sang-Woo
SW
Cha
Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, South Korea.
Jong Ho
JH
Moon
Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Seoul, Korea.
Young Deok
YD
Cho
Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea.
Sun-Joo
SJ
Kim
D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007275:Injections, Intravenous; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D010146:Pain / Q000517:prevention & control; D010147:Pain Measurement; D010182:Pancreatic Diseases / Q000628:therapy*; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol
elderly; endoscopic retrograde cholangiopancreatography; midazolam; propofol; sedation