Safety of continuous propofol sedation for endoscopic procedures in elderly patients.

OBJECTIVE: to evaluate safety of continuous propofol sedation in elderly patients who undergo endoscopic procedures and investigate risk factors to develop complications in the geriatric population. MATERIAL AND METHODS: patients who received endoscopist-directed propofol sedation were classified into two groups according to age. Group I: > 80 years; Group II: < 80 years. Propofol was administered by continuous intravenous infusion to achieve deep sedation. Arterial oxygen saturation, heart rate, blood pressure, and electrocardiographic records were monitored during the procedure. Therapy and complications secondary to sedation were recorded. RESULTS: one thousand two-hundred and ninety-five endoscopic procedures (gastroscopies, colonoscopies and endoscopic ultrasonographies) were included. The dose of propofol was lower and therapy was more frequently performed in Group I. There were no differences between sedation-related complications in both groups (Group I: 15.4%, Group II: 14%; p:n.s.). Patients in Group I showed greater tendency to develop severe oxygen desaturation in the colonoscopy and endoscopic ultrasonography procedures. In the univariate analysis, a higher dose of propofol was associated with the appearance of complications (157.4 ± 84.4 vs 121.3 ± 89.6 mg) in elderly patients but it was not associated with severe oxygen desaturation. CONCLUSIONS: continuous propofol sedation during endoscopic procedures in elderly patients > 80 years is as safe as in younger patients.

Seguridad de la sedación con perfusión continua de propofol en procedimientos endoscópicos en ancianos / No disponible

Objetivo: evaluar la seguridad de la sedación con perfusión continua de propofol en ancianos a los que se les realizan procedimientos endoscópicos e investigar los factores de riesgo para el desarrollo de complicaciones en la población anciana. Diseño experimental: estudio observacional prospectivo de cohortes. Pacientes: pacientes sedados mediante perfusión continua administrada por el propio endoscopista divididos en dos grupos: Grupo I: ≥ 80 años; Grupo II: < 80 años. El propofol fue administrado mediante perfusión continua para conseguir sedación profunda. Durante la exploración se monitorizó: saturación arterial de oxígeno, presión arterial y registro electrocardiográfico. Se registró además si se realizó terapéutica endoscópica y las complicaciones relacionadas con la sedación que se produjeron. Resultados: se incluyeron 1.295 procedimientos endoscópicos (gastroscopias, colonoscopias y ecoendoscopias). La dosis de propofol fue inferior y la endoscopia fue terapéutica con mayor frecuencia en el Grupo I. No hubo diferencias en la aparición de complicaciones relativas a la sedación entre ambos grupos. (Grupo I: 15,4%, Grupo II: 14%; p:n.s.). Los pacientes del Grupo I tuvieron una mayor tendencia a desarrollar desaturación grave durante la colonoscopia y ecoendoscopia. En el análisis univariante, en los pacientes ancianos, el incremento en la dosis de propofol se asoció con la aparición de complicaciones (157,4 ± 84,4 vs 121,3 ± 89,6 mg) pero no con la desaturación grave. Conclusiones: la sedación con perfusión continua de propofol en procedimientos endoscópicos en pacientes >= 80 años es tan segura como en pacientes más jóvenes(AU)

Objective: to evaluate safety of continuous propofol sedation in elderly patients who undergo endoscopic procedures and investigate risk factors to develop complications in the geriatric population. Material and methods: patients who received endoscopist-directed propofol sedation were classified into two groups according to age. Group I: ≥ 80 years; Group II: < 80 years. Propofol was administered by continuous intravenous infusion to achieve deep se - dation. Arterial oxygen saturation, heart rate, blood pressure, and electrocardiographic records were monitored during the procedure. Therapy and complications secondary to sedation were recorded. Results: one thousand two-hundred and ninety-five endoscopic procedures (gastroscopies, colonoscopies and endoscopic ultrasonographies) were included. The dose of propofol was lower and therapy was more frequently performed in Group I. There were no differences between sedation-related complications in both groups (Group I: 15.4%, Group II: 14%; p:n.s.). Patients in Group I showed greater tendency to develop severe oxygen desaturation in the colonoscopy and endoscopic ultrasonography procedures. In the univariate analysis, a higher dose of propofol was associated with the appearance of complications (157.4 ± 84.4 vs 121.3 ± 89.6 mg) in elderly patients but it was not associated with severe oxygen desaturation. Conclusions: continuous propofol sedation during endoscopic procedures in elderly patients >= 80 years is as safe as in younger patients(AU)

Update of the Atlanta Classification of severity of acute pancreatitis: should a moderate category be included?

BACKGROUND: Persistent and multiple organ failure (POF and MOF) are predictive of death in acute pancreatitis (AP). Local complications without organ failure are associated with morbidity but a low risk of mortality. AIM: To design a three-category classification of AP severity and to compare it with the Atlanta Classification (AC) in terms of morbidity and mortality. METHOD: Severe AP was defined as death, POF (>48 h) or MOF. Moderate AP was defined as the presence of acute collections and/or pancreatic necrosis. Mild AP was defined by exclusion. We compared this classification with AC in 144 episodes of AP. RESULTS: In the three-category classification, severe AP was associated with significantly more frequent intensive care unit admission, invasive treatment and mortality than moderate and mild AP (p < 0.01). Severe AP patients required longer hospital stay and more nutritional support than mild AP patients (p < 0.01). Patients with moderate AP had significantly longer hospital stay and more need for nutritional support than patients with mild AP (p < 0.01). Five patients died, all of them with MOF and/or POF. CONCLUSIONS: A three-category classification distinguishes three homogeneous groups of severity.