Key result
Very elderly patients (>86 years) undergoing gastrointestinal endoscopy with intravenous sedation experienced a higher rate of overall adverse events compared to younger patients, primarily transient hypotension, but required lower doses of sedatives.
Why the study?
Does intravenous sedation for gastrointestinal endoscopy have a different safety and efficacy profile in very elderly patients (>86 years) compared to younger patients?
Cohort (n=1,779)
No
Does intravenous sedation for gastrointestinal endoscopy have a different safety and efficacy profile in very elderly patients (>86 years) compared to younger patients?
Intravenous sedation for gastrointestinal endoscopy in very elderly patients requires lower sedative doses and is associated with more frequent, but manageable, minor adverse events like transient hypotension.
Answers are grounded in this paper and cite their sources.
May warrant lower sedative doses with closer monitoring in very elderly patients; this cohort study leaves open the need for prospective trials.
Background: The use of sedation for gastrointestinal endoscopy (GIE) procedures in elderly patients has been established as a safe and effective technique. However, it is still uncertain whether the situation is valid for Asians. Objective: Evaluate the outcome of intravenous sedation (IVS) for GIE procedures in very elderly patients (>86 years old) in Thailand and compare the clinical efficacy of IVS between very elderly and those younger (<86 years old) Methods: We undertook a retrospective review of the sedation service records of patients who underwent GIE procedures between 2007 and 2008 at Siriraj Hospital, Thailand. All sedations were administered by anesthetic personnel in the endoscopy room. The cohort was divided into three groups, <65 years old (group 1), 65-85 years old (group 2), and >86 years old (group 3). Results: Sedation was provided for 1,779 patients (965, 687, and 127 patients in group 1, 2, and 3, respectively) in 2,061 GIE procedures. Fentanyl, midazolam and propofol were the most common IVS drugs used in all three groups. Patients in group 3 required lower mean doses of these intravenous sedatives than those in group 1 or 2 (p <0.001). Mean procedure time in group 3 was longer than in group 1 or 2 (p=0.010). Adverse events in group 3 occurred more frequently when compared to group 1 or 2 (p <0.001). Transient hypotension was the main complication across all aged groups. Conclusion: IVS for GIE procedure in very elderly patients was associated with higher minor advance events but relatively safe and effective when carried out by trained anesthetic personnel with appropriate monitoring and dose adjustment.
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Amornyotin et al. (2011) conducted a cohort in Gastrointestinal endoscopy (n=1,779). Very elderly age (>86 years) during intravenous sedation vs. Younger age (<86 years) was evaluated on Overall sedation and procedure-related adverse events (p=<0.001). Very elderly patients (>86 years) undergoing gastrointestinal endoscopy with intravenous sedation experienced a higher rate of overall adverse events compared to younger patients, primarily transient hypotension, but required lower doses of sedatives.
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