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Sedation with propofol for routine ERCP in high-risk octogenarians: a randomized, controlled study.
Am J Gastroenterol. 2005 Sep; 100(9):1957-63.AJ

Abstract

OBJECTIVES

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).

CONCLUSION

Under careful monitoring the use of propofol for sedation during ERCP is superior to midazolam/meperidine even in high-risk octogenarians.

Authors+Show Affiliations

Department of Internal Medicine I (Gastroenterology and Interventional Endoscopy), Klinikum Hannover-Siloah, Teaching Hospital of the Hannover Medical School, Hannover, Germany.No affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

16128939

Citation

Riphaus, Andrea, et al. "Sedation With Propofol for Routine ERCP in High-risk Octogenarians: a Randomized, Controlled Study." The American Journal of Gastroenterology, vol. 100, no. 9, 2005, pp. 1957-63.
Riphaus A, Stergiou N, Wehrmann T. Sedation with propofol for routine ERCP in high-risk octogenarians: a randomized, controlled study. Am J Gastroenterol. 2005;100(9):1957-63.
Riphaus, A., Stergiou, N., & Wehrmann, T. (2005). Sedation with propofol for routine ERCP in high-risk octogenarians: a randomized, controlled study. The American Journal of Gastroenterology, 100(9), 1957-63.
Riphaus A, Stergiou N, Wehrmann T. Sedation With Propofol for Routine ERCP in High-risk Octogenarians: a Randomized, Controlled Study. Am J Gastroenterol. 2005;100(9):1957-63. PubMed PMID: 16128939.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sedation with propofol for routine ERCP in high-risk octogenarians: a randomized, controlled study. AU - Riphaus,Andrea, AU - Stergiou,Nikos, AU - Wehrmann,Till, PY - 2005/9/1/pubmed PY - 2005/11/8/medline PY - 2005/9/1/entrez SP - 1957 EP - 63 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 100 IS - 9 N2 - OBJECTIVES: 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). CONCLUSION: Under careful monitoring the use of propofol for sedation during ERCP is superior to midazolam/meperidine even in high-risk octogenarians. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/16128939/Sedation_with_propofol_for_routine_ERCP_in_high_risk_octogenarians:_a_randomized_controlled_study_ L2 - https://Insights.ovid.com/pubmed?pmid=16128939 DB - PRIME DP - Unbound Medicine ER -