| Theme |
Digestive Diseases of the Aged Over 85 -- the Characteristics and Therapeutic Points |
| Title |
Conscious Sedation and Preparation for the Elderly in the Endoscopic Procedure |
| Author |
Hiroshi Arakawa |
Department of Endoscopy, The Jikei University Kashiwa Hospital |
| Author |
Seita Koyama |
Department of Endoscopy, The Jikei University Kashiwa Hospital |
| Author |
Sei Adachi |
Department of Endoscopy, The Jikei University Kashiwa Hospital |
| Author |
Shintaro Tsukinaga |
Department of Endoscopy, The Jikei University Kashiwa Hospital |
| Author |
Mikio Kajihara |
Division of Gastroenterology and hepatology, Department of Internal Medicine, The Jikei University Kashiwa Hospital |
| Author |
Kan Uchiyama |
Division of Gastroenterology and hepatology, Department of Internal Medicine, The Jikei University Kashiwa Hospital |
| Author |
Shigeo Koido |
Division of Gastroenterology and hepatology, Department of Internal Medicine, The Jikei University Kashiwa Hospital |
| Author |
Toshifumi Ohkusa |
Division of Gastroenterology and hepatology, Department of Internal Medicine, The Jikei University Kashiwa Hospital |
| Author |
Hisao Tajiri |
Division of Gastroenterology and Hepatology, Department of Internal Medicine and Endoscopy, The Jikei University School of Medicine |
| Author |
Hiroaki Suzuki |
Department of Endoscopy, The Jikei University School of Medicine |
| [ Summary ] |
Geriatric patients exhibit the organic dysfunction characteristics of aging, resulting in decreased functional reserve with which to respond to acute stress. Very elderly patients also frequently have complex underlying disease processes, which influence their stress response. Aging is a major risk factor in endoscopic procedures, and must be taken into consideration when evaluating risk of conscious sedation during endoscopy. Conscious sedation prevents exacerbation of hypertension and tachycardia caused by the stress response during endoscopy ; however, respiratory inhibition associated with conscious sedation may result in upper airway obstruction, hypoxia, aspiration, hypoventilation, or respiratory arrest. Therefore, the risks of conscious sedation should be weighed carefully in patients with pulmonary disease. Elderly patients should receive reduced doses of sedative agents compared to those administered to healthy adults, and be observed for a longer period for sedative effect (3 to 5 minutes). After endoscopy in the elderly, optimal monitoring includes a 60‒minute period of observation in a recovery bed and someone to accompany the patient at home after discharge to prevent falls. |