Stepwise sedation for elderly patients with mild/moderate COPD during upper gastrointestinal endoscopy

Abstract

Aim: To investigate stepwise sedation for elderly patients with mild/moderate chronic obstructive pulmonary disease (COPD) during upper gastrointestinal (GI) endoscopy.

Methods: Eighty-six elderly patients with mild/moderate COPD and 82 elderly patients without COPD scheduled for upper GI endoscopy were randomly assigned to receive one of the following two sedation methods: stepwise sedation involving three-stage administration of propofol combined with midazolam [COPD with stepwise sedation (group Cs), and non-COPD with stepwise sedation (group Ns)] or continuous sedation involving continuous administration of propofol combined with midazolam [COPD with continuous sedation (group Cc), and non-COPD with continuous sedation (group Nc)]. Saturation of peripheral oxygen (SpO2), blood pressure, and pulse rate were monitored, and patient discomfort, adverse events, drugs dosage, and recovery time were recorded.

Results: All endoscopies were completed successfully. The occurrences of hypoxemia in groups Cs, Cc, Ns, and Nc were 4 (9.3%), 12 (27.9%), 3 (7.3%), and 5 (12.2%), respectively. The occurrence of hypoxemia in group Cs was significantly lower than that in group Cc (P < 0.05). The average decreases in value of SpO2, systolic blood pressure, and diastolic blood pressure in group Cs were significantly lower than those in group Cc. Additionally, propofol dosage and overall rate of adverse events in group Cs were lower than those in group Cc. Finally, the recovery time in group Cs was significantly shorter than that in group Cc, and that in group Ns was significantly shorter than that in group Nc (P < 0.001).

Conclusion: The stepwise sedation method is effective and safer than the continuous sedation method for elderly patients with mild/moderate COPD during upper GI endoscopy.

Keywords: Adverse events; Chronic obstructive pulmonary disease; Monitoring; Sedation; Upper gastrointestinal endoscopy.

Figure 1

Flow of participants throughout the trial. GI: Gastrointestinal; COPD: Chronic obstructive pulmonary disease; Group Cs: COPD with stepwise sedation; Group Cc: COPD with continuous sedation; Group Ns: Non-COPD with stepwise sedation; Group Nc: Non-COPD with continuous sedation.

Figure 2

Recovery times of patients in the four groups. Group Cs: Chronic obstructive pulmonary disease (COPD) with stepwise sedation; Group Cc: COPD with continuous sedation; Group Ns: Non-COPD with stepwise sedation; Group Nc: Non-COPD with continuous sedation. ^bP < 0.01 between Group Cs vs Group Cc and Group Ns vs Group Nc.