Brief Article
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World J Gastroenterol. Aug 7, 2013; 19(29): 4791-4798
Published online Aug 7, 2013. doi: 10.3748/wjg.v19.i29.4791
Stepwise sedation for elderly patients with mild/moderate COPD during upper gastrointestinal endoscopy
Can-Xia Xu, Xiong Chen, Yan Jia, Ding-Hua Xiao, Hui-Fang Zou, Qin Guo, Fen Wang, Xiao-Yan Wang, Shou-Rong Shen, Ling-Ling Tong, Ke Cao, Xiao-Ming Liu
Can-Xia Xu, Xiong Chen, Yan Jia, Ding-Hua Xiao, Hui-Fang Zou, Qin Guo, Fen Wang, Xiao-Yan Wang, Shou-Rong Shen, Xiao-Ming Liu, Department of Gastroenterology, Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Ling-Ling Tong, Department of Health Statistics, University of South China, Hengyang 421001, Hunan Province, China
Ke Cao, Department of Oncology, Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Author contributions: Xu CX designed the study, performed the endoscopic procedures, analyzed the data, and wrote the manuscript; Chen X, Jia Y, Xiao DH, Zou HF, Guo Q, Wang F, Wang XY and Shen SR performed the endoscopic procedures; Tong LL, Cao K, and Liu XM analyzed the data.
Supported by A Grant from the National Natural Science Foundation of China, No. 81172301
Correspondence to: Can-Xia Xu, MD, Professor, Department of Gastroenterology, Third Xiangya Hospital of Central South University, 138 Tongzipo Street, Changsha 410013, Hunan Province, China. xucanxia2000@hotmail.com
Telephone: +86-731-88618631 Fax: +86-731-88618012
Received: March 28, 2013
Revised: July 2, 2013
Accepted: July 9, 2013
Published online: August 7, 2013
Processing time: 130 Days and 18.7 Hours
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: Upper gastrointestinal endoscopy; Adverse events; Sedation; Monitoring; Chronic obstructive pulmonary disease

Core tip: Many patients with chronic obstructive pulmonary disease (COPD) have to undergo upper gastrointestinal (GI) endoscopy because of digestive symptoms. A sedation method specially designed for elderly patients with COPD is urgently needed for use in clinical practice. In this study, we designed a new stepwise sedation method. Eighty-six elderly patients with COPD and 82 elderly patients without COPD scheduled for upper GI endoscopy were randomly assigned stepwise sedation or continuous sedation. The results indicate that the stepwise sedation method is effective and safer than the continuous sedation method for elderly patients with mild/moderate COPD during upper GI endoscopy.