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

Table 1 Demographic data and clinical characteristics of the study population

Parameter	Group
	Cs (n= 43)	Cc (n= 43)	Ns (n= 41)	Nc (n= 41)
Sex: male/female	35/8	34/9	30/11	30/11
Age: yr, mean ± SD	74.5 ± 2.5	74.2 ± 2.3	77.6 ± 4.6	76.7 ± 4.6
(range)	(71-80)	(71-80)	(71-88)	(71-90)
Weight: kg, mean ± SD	56.3 ± 6.4	56.8 ± 6.6	56.5 ± 7.0	57.2 ± 6.5
(range)	(45-70)	(48-71)	(46-73)	(47-71)
Alcohol consumption: Y/N	7/36	5/38	6/35	4/37
Smoking: Y/N	28/15	26/17	24/17	22/19
COPD classification
I	28	30
II	15	13
ASA classification
I	0	0	35	37
II	11	13	6	4
III	32	30	0	0
Major endoscopic findings
Chronic superficial gastritis	14	11	13	15
Chronic atrophic gastritis	5	6	4	5
Gastric ulcer	6	5	7	4
Duodenal ulcer	8	7	9	6
Gastric cancer	3	4	2	3
Gastric polyp	2	3	2	4
Esophagus cancer	2	3	1	2
Reflux esophagitis	3	4	3	2

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; COPD: Chronic obstructive pulmonary disease; ASA: American Society of Anesthesiology; Y/N: Yes/no.

Table 2 Pharyngeal malaise when passing the endoscope through the throat n (%)

Group	n	Scores of degree of pharyngeal malaise
		0	1	2	3
Cs	43	33 (76.7)a	7 (16.3)	3 (7.0)	0
Cc	43	40 (93.0)	2 (4.7)	1 (2.3)	0
Ns	41	31 (75.6)a	6 (14.6)	4 (9.8)	0
Nc	41	38 (92.7)	2 (4.9)	1 (2.4)	0

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.

^aP < 0.05 between Group Cs vs Group Cc and Group Ns vs Group Nc.

Table 3 SpO₂, blood pressure, and pulse rate during the endoscopy procedure (mean ± SD)

Group	Time	SpO2 (%)	SBP (mmHg)	DBP (mmHg)	P (bpm)
Cs	Before	98.1 ± 1.6	126.0 ± 11.2	80.7 ± 6.7	74.4 ± 13.7
(n = 43)	During	95.8 ± 6.0b	115.6 ± 11.9b	72.8 ± 6.6b	73.8 ± 14.0
	After	98.0 ± 1.6	124.9 ± 11.3b	79.1 ± 6.5b	74.2 ± 14.1
Cc	Before	98.0 ± 1.8	128.5 ± 11.0	80.5 ± 5.6	77.2 ± 14.3
(n = 43)	During	90.7 ± 13.6b	113.5 ± 9.4b	71.0 ± 4.9b	75.0 ± 14.3b
	After	97.3 ± 2.6b	126.3 ± 11.0b	78.5 ± 5.8b	76.6 ± 14.5
Ns	Before	98.2 ± 1.8	130.2 ± 5.0	82.0 ± 4.1	73.7 ± 13.7
(n = 41)	During	96.5 ± 5.0a	120.0 ± 5.2b	74.3 ± 4.4b	73.0 ± 13.7
	After	98.1 ± 1.7	127.9 ± 5.0b	80.0 ± 4.3b	73.4 ± 13.6
Nc	Before	98.2 ± 1.8	127.8 ± 9.3	81.4 ± 2.6	70.4 ± 12.7
(n = 41)	During	95.6 ± 6.7b	117.1 ± 8.7b	73.5 ± 2.9b	69.0 ± 12.3b
	After	98.1 ± 1.7	125.5 ± 8.9b	79.0 ± 2.7b	70.4 ± 12.5

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; SpO₂: Saturation of peripheral oxygen; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; P: Pulse rate.

^aP < 0.05,

^bP < 0.01 vs before the endoscopy.

Table 4 Adverse events in the four treatment groups n (%)

Adverse events	Group
	Cs (n = 43)	Cc (n = 43)	Ns (n = 41)	Nc (n = 41)
Hypoxemia (SpO2 < 90% for ≥ 15 s)	4 (9.3)a	12 (27.9)	3 (7.3)	5 (12.2)
SpO2 89%-80%	2 (4.7)	5 (11.2)	2 (4.9)	3 (7.3)
SpO2 79%-60%	2 (4.7)	5 (11.2)	1 (2.4)	2 (4.9)
SpO2 59%-40%	0 (0.0)	1 (2.3)	0 (0.0)	0 (0.0)
SpO2 < 40%	0 (0.0)	1 (2.3)	0 (0.0)	0 (0.0)
Average decrease in value of SpO2	2.3 ± 5.4a	7.3 ± 12.6	1.7 ± 4.3	2.6 ± 5.8
Hypotension (SBP < 90 mmHg or DBP < 60 mmHg)	0 (0.0)	1 (2.3)	0 (0.0)	0 (0.0)
Extent of SBP decrease
≤ 10	28 (65.1)	17 (39.5)	34 (82.9)	28 (68.3)
11-20	15 (34.9)a	26 (60.5)	7 (17.1)	13 (31.7)
> 20	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
Average decrease in value of SBP	10.4 ± 3.3b	15.1 ± 6.8	10.2 ± 3.3	10.6 ± 4.5
Extent of DBP decrease
≤ 10	40 (93.0)	34 (79.1)	37 (90.2)	38 (92.7)
11-20	3 (7.0)	9 (20.9)	4 (9.8)	3 (7.3)
> 20	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
Average decrease in value of DBP	7.9 ± 2.2b	9.5 ± 1.8	7.6 ± 2.6	8.0 ± 1.7
Tachycardia (> 100 bpm)	3 (7.0)	2 (4.7)	2 (4.9)	1 (2.4)
Bradycardia (< 60 bpm)	3 (7.0)	6 (14.0)	3 (7.3)	4 (9.8)
Decrease of pulse rate	33 (76.7)	36 (83.7)	29 (70.7)	28 (68.3)
Increase of pulse rate	8 (18.6)	6 (14.0)	8 (19.5)	8 (19.5)
No change of pulse rate	2 (4.7)	1 (2.3)	4 (9.8)	5 (12.2)
Average change in value of pulse rate	0.6 ± 2.8a	2.2 ± 2.8	0.7 ± 2.4	1.4 ± 2.5
Arrhythmias	2 (4.7)	1 (2.3)	1 (2.4)	0 (0.0)
Other adverse events	3 (7.0)	5 (11.6)	2 (4.9)	3 (7.3)
Extrapyramidal reactions	0 (0.0)	1 (2.3)	0 (0.0)	0 (0.0)
Somnolence	1 (2.3)	2 (4.7)	1 (2.4)	1 (2.4)
Dizziness	2 (4.7)	2 (4.7)	1 (2.4)	2 (4.9)
Overall rate of adverse events	15 (34.9)b	27 (62.8)	11 (26.8)	13 (31.7)

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; SpO₂: Saturation of peripheral oxygen; SBP: Systolic blood pressure; DBP: Diastolic blood pressure. Overall rate of adverse events included hypoxemia, hypotension, tachycardia, bradycardia, arrhythmias and other adverse events.

^aP < 0.05,

^bP < 0.01 vs Group Cc.