Incidence of adverse events among elderly vs younger adult patients during procedural sedation with propofol
Shimizu H, Homma Y, Takase H, Shimosato A, Norii T, and Jayaprakash N. Incidence of adverse events among elderly vs younger adult patients during procedural sedation with propofol. Acad Emerg Med 2019; 26:S43.
Acad Emerg Med
Background: Propofol has been used for procedural sedation and analgesia (PSA) in all age groups. Due to the narrow therapeutic index, propofol has a potentially high risk of adverse events (AE), particularly in elderly patients; however, the incidence of AE in elderly patients has not been well described. We aimed to determine the incidence of AEs during PSA with propofol in elderly patients and hypothesized that elderly patients have higher incidence of AE compared to younger adults. Methods: We conducted a 6-center prospective observational study in Japan, the Japanese Procedural SedaTion and Analgesia Registry(JPSTAR). We prospectively collected data on all patients undergoing PSA in the ED from May 2017 through December 2018. We included all adult patients (18 years or older) who received propofol for PSA and excluded patients who received multiple sedatives. AEs included both serious (e.g., cardiac arrest) and other less serious AEs (e.g., transient hypoxia). We compared the incidence of AE for elderly patients (65 years or older) to non-elderly adults. We used Fisher's exact test for categorical data and Wilcoxon Rank Sum tests for continuous data for statistical comparisons. Results: Among 570 patients in the registry, 122 patients received propofol. Fifty-eight (47.5%) of patients were 65 years or older. The most common indication was reduction of joint dislocations or fracture in both elderly and younger adult groups (46.5% vs 65.6%, p=0.04). The elderly group received significantly lower doses of propofol compared to the younger adult group, but the incidence of AE was higher in the elderly group (32.8% vs. 15.6%, p=0.03). There were no serious AE in either groups Conclusion: Elderly patients had higher incidence of AE during PSA with propofol despite the fact they received lower dose. Emergency physicians should be cautious in using propofol for PSA in elderly patients.