Adequate patient sedation is mandatory for diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP).
In this respect it is known that the short-acting anesthetic propofol offers certain potential advantages for sedation during ERCP.
There are no controlled studies concerning the feasibility and safety of propofol sedation in elderly, high-risk patients.
Dr Andrea Riphaus and colleagues from Germany included 150 consecutive patients aged 80 years with high comorbidity.
The researchers randomized 75 patients to midazolam plus meperidine and 75 to propofol alone for sedation during ERCP.
The research team continuously monitored the patients' vital signs.
Procedure-related parameters, recovery time, and quality as well as patients' cooperation and tolerance of the procedure were assessed.
| Temporary oxygen desaturation less than 90% occurred in 8 of the propofol-group|
|American Journal of Gastroenterology|
The team observed clinically relevant changes in vital signs at comparable frequencies.
The researchers found that temporary oxygen desaturation less than 90% occurred in 8 patients in the propofol-group and in 7 receiving midazolam/meperidine.
Hypotension was documented in 2 patients in the propofol group and 1 patient receiving midazolam/meperidine.
The team noted that propofol provided a significantly better patient cooperation than midazolam/meperidine.
However, the researchers found that procedure tolerability was rated nearly the same by both groups.
Mean recovery time was significantly shorter in the propofol group at 22 min vs 31 min for midazolam/meperidine.
The team noted that the recovery score was significantly higher under propofol at 8 vs 6 for midazolam/meperidine.
During recovery, the researchers observed desaturation events in 12% of the propofol group and 26% in the midazolam/meperidine group.
Dr Riphaus's team commented, “Under careful monitoring the use of propofol for sedation during ERCP is superior to midazolam/meperidine even in high-risk octogenarians.”