Conscious sedation with propofol in elderly patients: a prospective evaluation

Aim: To characterize the safety of endoscopic procedures and propofol use as administered by nurses in a cohort of elderly patients. Methods: During 19 months all endoscopy patients > 70 years were eligible for this prospective observational study. Patients were assigned to group A (70-85 years) or group B (> 85 years). Records from all patients < 70 years treated during the same period served as controls. Specially trained nurses administered the propofol and monitored for complications (decrease in the peripheral oxygen saturation, mean arterial pressure or heart rate). Results: There were 1435 endoscopic procedures in group A and 351 in group B. There was no procedure or sedation-related mortality, nor a significantly greater need for emergency intervention than in the control group. Two patients required short mask ventilation but recovered without sequelae. Compared with younger patients, there was a significant increase in risk for a short oxygen desaturation < 90% and a decrease in oxygen saturation > 5%. Arterial hypotension occurred significantly more often in the control group than among the aged patients. Conclusions: This present study documents that gastrointestinal endoscopic procedures are safe and well tolerated even in the very elderly. Nurse-administered propofol is a safe and reasonable sedation method in these patients.