PMID- 26301406
OWN - NLM
STAT- MEDLINE
DCOM- 20161222
LR  - 20161230
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 83
IP  - 4
DP  - 2016 Apr
TI  - Propofol sedation with a target-controlled infusion pump and bispectral index
      monitoring system in elderly patients during a complex upper endoscopy procedure.
PG  - 756-64
LID - 10.1016/j.gie.2015.08.034 [doi]
LID - S0016-5107(15)02806-0 [pii]
AB  - BACKGROUND AND AIMS: 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 mug/mL [interquartile range
      (IQR), 1.9-2.3]; group B: median 1.6 mug/mL [IQR, 1.3-1.8]; and group C: median
      1.4 mug/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.
CI  - Copyright (c) 2016 American Society for Gastrointestinal Endoscopy. Published by 
      Elsevier Inc. All rights reserved.
FAU - Gotoda, Tatsuhiro
AU  - Gotoda T
AD  - Department of Gastroenterology and Hepatology, Okayama University Graduate School
      of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
FAU - Okada, Hiroyuki
AU  - Okada H
AD  - Department of Endoscopy, Okayama University Hospital, Okayama, Japan.
FAU - Hori, Keisuke
AU  - Hori K
AD  - Department of Gastroenterology and Hepatology, Okayama University Graduate School
      of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
FAU - Kawahara, Yoshiro
AU  - Kawahara Y
AD  - Department of Endoscopy, Okayama University Hospital, Okayama, Japan.
FAU - Iwamuro, Masaya
AU  - Iwamuro M
AD  - Department of Gastroenterology and Hepatology, Okayama University Graduate School
      of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
FAU - Abe, Makoto
AU  - Abe M
AD  - Department of Gastroenterology and Hepatology, Okayama University Graduate School
      of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
FAU - Kono, Yoshiyasu
AU  - Kono Y
AD  - Department of Gastroenterology and Hepatology, Okayama University Graduate School
      of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
FAU - Miura, Kou
AU  - Miura K
AD  - Department of Gastroenterology and Hepatology, Okayama University Graduate School
      of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
FAU - Kanzaki, Hiromitsu
AU  - Kanzaki H
AD  - Department of Gastroenterology and Hepatology, Okayama University Graduate School
      of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
FAU - Kita, Masahide
AU  - Kita M
AD  - Department of Gastroenterology and Hepatology, Okayama University Graduate School
      of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
FAU - Kawano, Seiji
AU  - Kawano S
AD  - Department of Endoscopy, Okayama University Hospital, Okayama, Japan.
FAU - Yamamoto, Kazuhide
AU  - Yamamoto K
AD  - Department of Gastroenterology and Hepatology, Okayama University Graduate School
      of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
LA  - eng
PT  - Journal Article
DEP - 20150822
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
RN  - 0 (Hypnotics and Sedatives)
RN  - YI7VU623SF (Propofol)
SB  - IM
MH  - Adult
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Blood Pressure
MH  - *Deep Sedation/adverse effects/instrumentation
MH  - Dissection
MH  - Drug Monitoring/instrumentation
MH  - Endoscopy, Gastrointestinal/*methods
MH  - Female
MH  - Gastric Mucosa/*surgery
MH  - Humans
MH  - Hypnotics and Sedatives/*administration & dosage/adverse effects/blood
MH  - Hypotension/chemically induced
MH  - Hypoxia/chemically induced
MH  - Infusion Pumps
MH  - Lung/physiopathology
MH  - Male
MH  - Middle Aged
MH  - Monitoring, Intraoperative/instrumentation
MH  - Propofol/*administration & dosage/adverse effects/blood
MH  - Stomach Neoplasms/*surgery
MH  - Systole
EDAT- 2015/08/25 06:00
MHDA- 2016/12/23 06:00
CRDT- 2015/08/25 06:00
PHST- 2015/03/16 00:00 [received]
PHST- 2015/08/06 00:00 [accepted]
PHST- 2015/08/25 06:00 [entrez]
PHST- 2015/08/25 06:00 [pubmed]
PHST- 2016/12/23 06:00 [medline]
AID - S0016-5107(15)02806-0 [pii]
AID - 10.1016/j.gie.2015.08.034 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2016 Apr;83(4):756-64. doi: 10.1016/j.gie.2015.08.034. Epub 
      2015 Aug 22.