Propofol Sedation with a Target-Controlled Infusion Pump and Bispectral Index Monitoring System in Older Patients...

Adequate sedation is essential for balloon-assisted enteroscopy (BAE). While propofol sedation using target-controlled infusion (TCI) and bispectral index (BIS) monitoring is considered effective, its safety in older patients undergoing antegrade BAE remains unclear. This study evaluated the safety and efficacy of TCI/BIS-guided propofol sedation in older patients.

In this retrospective study, 369 patients who underwent antegrade BAE under propofol sedation between April 2017 and March 2024 were categorized into three age groups: younger (< 50 years, N = 123), middle-aged (50-69 years, N = 121), and older (≥ 70 years, N = 125). Propofol dosage, sedation-related adverse events, and procedural outcomes were compared. Multivariate analysis was compared to identify risk factors for major sedation-related events, including hypoxemia, hypotension, bradycardia.

Older patients required significantly lower target concentrations and total doses of propofol than younger and middle-aged patients (younger: 2.0 µg/mL, middle-aged: 1.6 µg/mL, older: 1.4 µg/mL, P < 0.01; younger: 414 mg, middle-aged: 312 mg, older: 212 mg, P < 0.01). Induction time was significantly longer in younger patients (P < 0.01). Major sedation-related adverse event rates did not significantly differ by age group. Multivariate analysis showed no association between age and adverse events. Low preoperative systolic blood pressure increased the risk of hypotension (OR = 2.32), chronic respiratory disease increased the risk of hypoxemia (OR = 2.97), and ASA class III increased the risk of bradycardia (OR = 3.38). All procedures were completed successfully without severe adverse events.

TCI/BIS-guided propofol sedation may be acceptable for older patients undergoing antegrade BAE, who require a lower propofol dose than younger patients.