Conscious sedation with propofol in elderly patients: a prospective evaluation L. T. HEUSS*, P. SCHNIEPER*, J. DREWE  E. PFLIMLIN* & C. BEGLINGER* *Department of Gastroenterology and  Department of Clinical Pharmacology, University Hospital Basel, Basel, Switzerland Accepted for publication 7 April 2003 SUMMARY Aim: To characterize the safety of endoscopic procedures and propofol use as administered by nurses in a cohort of elderly patients. Methods: During 19 months all endoscopy patients > 70 years were eligible for this prospective observational study. Patients were assigned to group A (70–85 years) or group B (> 85 years). Records from all patients < 70 years treated during the same period served as controls. Specially trained nurses administered the propofol and monitored for complications (decrease in the peripheral oxygen saturation, mean arterial pressure or heart rate). Results: There were 1435 endoscopic procedures in group A and 351 in group B. There was no procedure or sedation-related mortality, nor a significantly greater need for emergency intervention than in the control group. Two patients required short mask ventilation but recovered without sequelae. Compared with younger patients, there was a significant increase in risk for a short oxygen desaturation < 90% and a decrease in oxygen saturation > 5%. Arterial hypotension occurred significantly more often in the control group than among the aged patients. Conclusions: This present study documents that gastro- intestinal endoscopic procedures are safe and well tolerated even in the very elderly. Nurse-administered propofol is a safe and reasonable sedation method in these patients. INTRODUCTION In Western countries, an increasing proportion of the population is reaching an advanced age. For example, in Switzerland in 1970, 1.8% of the population was 80 years or older; by the year 2000, this figure had more than doubled to 4.0%, and projections for the year 2010 indicate this number will be almost 5%. 1 Even today, the proportion of urban inhabitants older than 64 years is already one-third of the population, and this trend will most likely continue. 2 Considering these demographic population changes, treatment of the elderly and very old patients plays an increasingly important role in the delivery of gastrointestinal healthcare. Patients, as well as their relatives, have growing expectations of being able to benefit from, compared to surgery, less invasive procedures, such as diagnostic but especially therapeutic endoscopic interventions. In addition, gastrointestinal endoscopy procedures are now better tolerated due to technological progress made in recent decades; elderly patients are therefore more likely to undergo such procedures. Although concerns regarding the safety and potential benefits of endoscopic procedures in elderly patients have been raised in the past, newer data show that gastrointestinal endoscopy can be safe and well tolerated, even in very old patients. 3, 4 One significant factor in performing better-tolerated endoscopies is the use of conscious or (as newly renamed) moderate sedation during the procedure. As standard practice, the use of benzodiazepines, such as diazepam Correspondence to: L. T. Heuss, MD, Department of Gastroenterology, University Hospital, Petersgraben 4, 4031 Basel, Switzerland. E-mail: Lheuss@uhbs.ch Aliment Pharmacol Ther 2003; 17: 1493–1501. doi: 10.1046/j.0269-2813.2003.01608.x Ó 2003 Blackwell Publishing Ltd 1493