Total Intravenous Anaesthesia

SAŽETAK
          Anestezija vođena ciljnom koncentracijom lijeka (Target controlled infusion - TCI) je tehnika je primjene lijeka pomoću infuzijske pumpe koja koristi farmakokinetičke modele za izračun stopa infuzije potrebnih za postizanje željene ciljne koncentracije u plazmi ili efektoronom organu. Nefleksibilnost manualnih infuzijskih sustava i kompleksnost izračuna potrebnih za fleksibilno doziranje lijekova dovelo je do razvoja računala za kontroliranu primjenu anestezioloških lijekova (1). Liječnik anesteziolog određuje ciljne koncentracije (mcg/mL ili ng/mL), a ne brzina infuzije koja će biti odabrana za standardnu infuzijsku pumpu (npr, mcg/kg/minuti). Najčešće korišteni lijekovi u TCI tehnici su Propofol, Sufentanil i Remifentanil. Kod primjene Propofola koristi se Marsh i Schnider model, za primjenu Sufentanila koristi se Gepts model, a za primjenu Remifentanila Minto model. Primarna razlika između TCI i ručno prilagođene infuzije ili bolus primjene je da TCI sustav smanjuje stope infuzije na račun distribucije i eliminacije lijeka. TCI tehnika omogućava anesteziologu da primijeni lijek titrirajući željenu ciljnu koncentraciju u krvi umjesto da titrira brzinu infuzije prema odgovoru pacijenta. Mikroprocesor automatski izračunava potrebnu brzinu infuzije kako bi se postigla i održala željena ciljna koncentracija lijeka u krvi.
Cilj ovog rada jest steči nova i unaprijediti postojeća znanja vezana uz primjenu TCI sustava odnosno anestezije vođene ciljnom koncentracijom lijeka koja predstavlja sigurniju i kvalitetniju anesteziološku tehniku.

Ključne riječi: anestezija, TCI sustav, ciljna koncentracija lijeka, Diprifusor

Introduction: Inhalational anesthesia with spontaneous respiration is traditionally used to facilitate airway endoscopy in children. The potential difficulties in maintaining adequate depth of anesthesia using inhalational anesthesia and the anesthetic pollution of the surgical environment are significant disadvantages of this technique. We report our institutional experience using total intravenous anesthesia (TIVA) and spontaneous respiration. Methods: We prospectively studied 41 pediatric patients undergoing 52 airway endoscopies and airway surgeries. Following induction of anesthesia, a propofol infusion was titrated to a clinically adequate level of anesthesia, guided by the Bispectral Index (BIS), and a remifentanil infusion was titrated to respiratory rate. ECG, BP, pulse oximetry, BIS level, transcutaneous CO 2 (TcCO 2 ), respiratory rate, and drug infusion rates were recorded. Adverse events and the response to these events were also recorded. Results: Forty-one children underwent 52 airway procedures; 17 rigid bronchoscopies and 35 microlaryngobronchoscopies, including 18 LASER treatments, were performed. The mean (SD SD) age was 6.9 (5.8) years and weight 26.9 (21.2) kg. The mean induction time was 13 (6) min, and anesthesia duration was 49 (30) min. The mean highest TcCO 2 recorded during the procedures was 62.8 ± 15.3 mmHg. Coughing occurred in 14 (27%) patients, requiring additional topical anesthesia (3), a bolus of propofol (4) or remifentanil (1), or removal of the bronchoscope (1). Desaturation below 90% occurred in 10 (19%) cases; only three required intervention in the form of temporary assisted ventilation (2) or inhaled bronchodilators (1). No laryngospasm, stridor, or arrhythmias were observed. Conclusion: TIVA and spontaneous respiration is an effective technique to manage anesthesia for airway endoscopy and surgery in children.

Background and Goal of study: Small bowel enteroscopy procedure is an invasive procedure for diagnosis and treatment in patients with abnormality of gastrointestinal tract especially for small bowel. It commonly performed with deep sedation. The efficacy and the complication rate by which a sick patient is sedated remains controversial. The aim of the study was to evaluate and compare the clinical efficacy of propofol based deep sedation (PBDS) for small bowel enteroscopy procedure in sick (American Society of Anesthesiologists [ASA] physical status III-IV) and nonsick (ASA physical status I-II) patients in a teaching hospital in Thailand.

Background and Goal of Study
Chronic post-operative pain (CPOP) is an increasing public health issue considering its impact on the patients quality of life and
and the associated costs for the healthcare system. The incidence of CPOP can be as high as 75%, depending on the surgical procedure
and other factors. Lidocaine is a local anesthetic with anti-inflammatory, analgesic and antihyperalgesic properties. Several
studies have shown its use in controlling acute post-operative pain when used intravenously. The goal of this study was to define
the role of intravenous lidocaine in preventing CPOP.
Materials and Methods
The PubMed database was searched from 2006 and 2019 with the keywords: “Chronic post-operative pain” or “Chronic post-surgical
pain” or “Chronic pain” and “Intravenous lidocaine”. Adequate papers for the purpose of this study were selected.
Results and Discussion
Three randomized controlled trials that met criteria were obtained: two on breast surgery and the other on open nephrectomy.
All trials used intravenous lidocaine during surgery, suspending the infusion up to the first 24-hours of the post-operative period.
All three of them showed a significant decrease on the incidence of CPOP. There was a 20-fold decrease six months after breast
surgery.
Conclusion
Intravenous lidocaine seems to decrease the incidence of CPOP however, there is limited evidence. More trials are necessary to
define the efficacy and safety of intravenous lidocaine. A generally accepted definition of CPOP is needed.

Objectives. To evaluate and compare the complication rate of sedation with or without propofol regimen for percutaneous endoscopic gastrostomy (PEG) in a hospital in Thailand. Subjects and Methods. A total of 198 patients underwent PEG procedures by using intravenous sedation (IVS) from Siriraj Hospital, Thailand from August 2006 to January 2009. The primary outcome variable was the overall complication rate. The secondary outcome variables were sedation and procedure related complications, and mortality rate. Results. After matching ASA physical status and indications of procedure, there were 92 PEG procedures in propofol based sedation group (A) and 20 PEG procedures in non-propofol based sedation group (B). All sedation was given by residents or anesthetic nurses directly supervised by staff anesthesiologist in the endoscopy room. There were no significant differences in patients' characteristics, sedation time, indication, complications, anesthetic personnel and mortality rate between the two groups. All complications were easily treated, with no adverse sequelae. Mean dose of fentanyl and midazolam in group A was significantly lower than in group B. Conclusion. Propofol-based sedation does not increase rate of complication during PEG procedure. Additionally, IVS of PEG procedure is relatively safe and effective when performed by physicians in training. Serious complications are none.

Introduction: Moderate to deep sedation is generally used for endoscopic retrograde cholangiopancreatography (ERCP). The depth of sedation is usually judged by clinical assessment and electroencephalography-guided monitoring. The aim of this study was to compare the clinical efficacy of clinical assessment and Narcotrend TM monitoring during deep-sedated ERCP. Methods: One hundred patients who underwent ERCP in a single year were randomly assigned to either group C or group N. Patients in group C (52) were sedated using the Modified Observer ' s Assessment of Alertness/Sedation (MOAA/S) scale. Patients in group N (48) were sedated using the Narcotrend TM system. The MOAA/S scale 1 or 2 and the Narcotrend TM index 47-56 to 57-64 were maintained during the procedure. The primary outcome variable of the study was the successful completion of the endoscopic procedure. The secondary outcome variables were the total dose of propofol used during the procedure, complications during and immediately after procedure, and recovery time. Results: All endoscopies were completed successfully. The mean total dose of propofol in group C was significantly lower than that in group N. However, the mean dose of propofol, expressed as dose/kg or dose/kg/h in both groups, was not significantly different (P = 0.497, 0.136). Recovery time, patient tolerance and satisfaction, and endoscopist satisfaction were comparable between the two groups. All sedation-related adverse events during and immediately after the procedure, such as hypotension, hypertension, tachycardia, bradycardia, transient hypoxia, and upper airway obstruction, in group C (62.2%) were significantly higher than in group N (37.5%) (P = 0.028). Conclusion: Clinical assessment and Narcotrend TM -guided sedation using propofol for deep sedation demonstrated comparable propofol dose and recovery time. Both monitoring systems were equally safe and effective. However, the Narcotrend TM -guided sedation showed lower hemodynamic changes and fewer complications compared with the clinical assessment-guided sedation.

Purpose: The aim of this phase II study is to compare toxicity and dose intensity (DI) between four-week (4w) and three-week (3w) schedule of gemcitabine (GEM) for advanced pancreatic cancer (PC). Methods: Patients with histologically or cytologically proven locally advanced and/or metastatic PC were assigned to receive GEM in 4w schedule or 3w schedule. The protocol of GEM was as follows: 4w schedule (1,000mg/m2 on days 1, 8 and 15 of each 28-day cycle), 3w schedule (1,000mg/m2 on days 1 and 8 of each 21-day cycle). If grade 3 to 4 hematological toxicity (only a platelate count was defined <70.000/mm3 based on the report of the late phase II study in Japanese patients with lung cancer) or grade 2 to 4 non-hematological toxicity was recorded during the previous cycle, administration was withheld for a week, and GEM dose was gradually reduced by 200mg/m2. The eligibility criteria included no prior therapy, Karnofsky PS >= 50%, age between 20 and 80 years, and adequate organ function. Written informed consent was obtained from all patients. The primary endpoint was a compliance rate of protocol regimen within eight weeks after initiation of chemotherapy, which was defined as the proportion of patients without a dose reduction or a delay in administration of GEM. Secondary endpoints were DI, safety, response rate and overall survival. Results: A total of 90 patients (4w: 3w schedule= 45: 45) were enrolled between January 2006 and October 2008. Baseline patient and disease characteristics were similar in both schedules. Median age was 67 (range, 49-79) years in 4w schedule vs. 66 (range, 33-79) years in 3w schedule; p=0.67. KPS (70-80: 90-100%) was (4: 41) vs. (5: 40); p=0.99. Disease (locally advanced: metastatic) was (7: 38) vs. (7: 38); p=0.99. The eight week-compliance rate of protocol regimen was the same; 53.3% (24/45) in both schedules. However, median duration of accumulative rate for adverse events tended to be extended in 3w schedule; 35days (6-334) vs. 49 (6-414), p=0.20. Consequently, the mean received DI was equivalent in both schedules; 588 +/-130 mg/m2/week vs. 550 +/-116, p=0.14. Grade 3-4 neutropenia was a major adverse event in both schedules; 37.7% (17/ 45) vs. 35.5 (16/45); p=0.82, in contrast, thrombocytopenia was significantly increased in 4w schedule; 26.6% (12/45) vs. 4.4 (2/45); p=0.009. Tumor response rate was 14.2% (5/ 35) vs. 17.1(6/35); p=0.92, and the disease control rate (PR, SD) was 60.0% (27/45) vs. 62.2 (28/45); p=0.82. Median survival time was 206 (33-802) days vs. 250 (39-681); p= 0.84. Conclusions: These results support the efficacy and safety in 3w schedule of GEM for PC. BACKGROUND AND AIMS: CTE is highly sensitive and specific for detecting small bowel disease, and influences diagnosis or management in a majority of cases. However, acceptance by patients is limited by discomfort due to nasoduodenal intubation. Sedation options are limited by aspiration risk during contrast infusion. This study aims to determine the efficacy and safety of the self-administered inhaled analgesic, methoxyflurane, for CTE. METHODS: A prospective randomized double-blind placebo-controlled trial was performed in patients referred for CTE. Patients received 3 ml methoxyflurane or saline (scented to maintain blind) via the Penthrox® inhaler (Medical Developments International, Melbourne, Australia). Patient comfort during each stage of the procedure (nasoduodenal intubation, contrast infusion, high resolution multislice abdominal CT) and an overall rating were recorded by patients 1 h post-procedure on a 10 cm visual analog scale (VAS). VAS was also used for radiologist-rated ease of nasoduodenal intubation and patient-rated ease of use of inhaler. Inhalers were weighed before and after use to enable calculation of the dose consumed. Immediate adverse events were recorded and patients re-interviewed at 48 hours for delayed events and to assess willingness to undergo a repeat procedure if required in future. RESULTS: 60 patients (mean age 45, range 18-84 years, 19 men) were enrolled. 30 received methoxyflurane. They were well matched to 30 receiving placebo. Procedural success was 98%. The small bowel was normal in 21 and 20 had changes of Crohn's disease. The mean dose of methoxyflurane consumed was 0.9 (SD 0.5) ml. Scores for comfort levels, ease of intubation and ease of use of inhaler are detailed in the The inhalation was well tolerated and there were no episodes of aspiration, hypoxia or anaphylaxis. Rates of willingness to undergo repeat procedure if required were 67% for methoxyflurane versus 62% for placebo (p=0.14).

Introduction: Moderate to deep sedation is generally used for endoscopic retrograde cholangiopancreatography
(ERCP). The depth of sedation is usually judged by clinical
assessment and electroencephalography-guided monitoring. The aim of this study was to compare the clinical efficacy of clinical assessment and NarcotrendTM monitoring during deep-sedated ERCP.
Methods: One hundred patients who underwent ERCP in a single year were randomly assigned to either group C or group N. Patients in group C (52) were sedated using the Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) scale. Patients in group N (48) were sedated using the NarcotrendTM system. The MOAA/S scale 1 or 2 and the NarcotrendTM index 47–56 to 57–64 were maintained during the procedure. The primary outcome variable of
the study was the successful completion of the endoscopic procedure. The secondary outcome variables were the total dose of propofol used during the procedure, complications during and immediately after procedure, and recovery time.
Results: All endoscopies were completed successfully. The mean total dose of propofol in group C was significantly lower than that in group N. However, the mean dose of propofol, expressed as dose/kg or dose/kg/h in both groups, was not significantly different (P = 0.497, 0.136). Recovery time, patient tolerance and satisfaction, and endoscopist satisfaction were comparable between the two groups. All sedation-related adverse events during and immediately after the procedure, such as hypotension, hypertension, tachycardia, bradycardia, transient hypoxia, and upper airway obstruction, in group C (62.2%) were significantly higher than in group N (37.5%) (P = 0.028).
Conclusion: Clinical assessment and NarcotrendTM-guided sedation using propofol for deep sedation demonstrated comparable propofol dose and recovery time. Both monitoring systems were equally safe and effective. However, the NarcotrendTM-guided sedation showed lower
hemodynamic changes and fewer complications compared with the clinical assessment-guided sedation.

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) procedures in elderly patients are on the rise, and they play an important role in the diagnosis and management of various gastrointestinal diseases. The use of deep sedation in these patients has been established as a safe and effective technique in Western countries; however, it is uncertain if the situation holds true among Asians. The present study aimed to evaluate the age-dependent safety analysis and clinical efficacy of propofol-based deep sedation (PBDS) for ERCP and EUS procedures in adult patients at a World Gastroenterology Organization (WGO) Endoscopy Training Center in Thailand.
Methods: We undertook a retrospective review of anesthesia or sedation service records of patients who underwent ERCP and EUS procedures. All procedures were performed by staff endoscopists, and all sedations were administered by anesthesia personnel in the endoscopy room.
Results: PBDS was provided for 491 ERCP and EUS procedures. Of these, 252 patients (mean age, 45.1 ± 11.1 years, range 17–65 years) were in the ,65 age group, 209 patients (mean age, 71.7 ± 4.3 years, range 65–80 years) were in the 65–80 year-old group, and 30 patients (mean age, 84.6 ± 4.2 years, range 81–97 years) were in the .80 age group. Common indications for the procedures were pancreatic tumor, cholelithiasis, and gastric tumor. Fentanyl, propofol, and midazolam were the most common sedative drugs used in all three groups. The mean doses of propofol and midazolam in the very old patients were relatively lower than in the other groups. The combination of propofol, midazolam, and fentanyl, as well as propofol and fentanyl, were frequently used in all patients. Sedation-related adverse events and procedure-related complications were not statistically significantly different among the three groups. Hypotension was the most common complication.
Conclusion: In the setting of the WGO Endoscopy Training Center in a developing country, PBDS for ERCP and EUS procedures in elderly patients by trained anesthesia personnel with appropriate monitoring is relatively safe and effective. Although adverse cardiovascular events, including hypotension, in this aged group is common, all adverse events were usually transient, mild, and easily treated, with no sequelae.

SightSaver TM visual stimulator is a reliable method for intraoperative visual evoked potential monitoring. Total intravenous anesthesia (TIVA) leads to higher VEP amplitude and shorter latencies, compared to balanced general anesthesia. TIVA is the most efficient anesthesia regimen for monitoring VEP during prone spinal surgeries. a b s t r a c t Objective: To determine the comparison of its clinical utility and safety profile for visual evoked potential (VEP) monitoring during prone spine surgeries under total intravenous anesthesia (TIVA) versus balanced general anesthesia using the SightSaver TM visual stimulator. Methods: The protocol was designed as a pilot, single center, prospective, randomized, and double-arm study. Subjects were randomized to receive either TIVA or balanced general anesthesia. Following induction and intubation, 8 electrodes were placed subcutaneously to collect VEP recordings. The SightSaver TM visual stimulator was placed on the subject's scalp before prone positioning. VEP waveforms were recorded every 30 min and assessed by a neurophysiologist throughout the length of surgery. Results: A total of 19 subjects were evaluated and VEP waveforms were successfully collected. TIVA group showed higher amplitude and lower latency than balanced anesthesia. Conclusions: Our data suggested that TIVA is associated with higher VEP amplitude and shorter latencies than balanced general anesthesia; therefore, TIVA could be the most efficient anesthesia regimen for VEP monitoring. Significance: The findings help to better understand the effect of different anesthesia regimens on intra-operative VEP monitoring.

Introduction Emotions and cognition are tightly bound entities that have clear functional and organic basis [1]. Both of them can be disturbed in hospitalized patient. Negative emotions, like fear and anxiety infl uence the patients undergoing anaesthesia regardless of age, and this impact has been extensively discussed in the literature [2–4]. On the other hand, cognition is affected by perioperative stress and anaesthesia infl u-encing the quality of life which has also been well described by Steinmetz et al. [5]. Emotions and cogni-tion are also engaged in the process of time production [6]. We know from the previous studies that anxiety and depression affect the intestinal motor function [7, 8]. These facts inspired us to construct the study assessing the relationship between emotional and cognitive aspect of time perception in relation to intravenous anaesthesia for endoscopic procedures. Especially that brain regions responsible for the interval timing (corticostriatal circuits and dopamine neu-rons) are closely related to cognitive phenomena and can be discussed as a part of human cognitive func-ABSTRACT Introduction. The basic goals of the study were to analyze how patients receiving intravenous anaesthesia for endoscopy produce one-minute time intervals after anaesthesia, and to characterize the relationship between attitude towards time and the production of one-minute intervals. Material and methods. Twenty four intravenously anesthetized patients constituted the Anaesthesia Group and 25 nonanesthetized patients formed the Control Group. The Mini-Mental State Examination and the Sense of Coherence Meaningfulness Subscale were used to recognize the problem of dementia and depression, the Time Metaphors Questionnaire was used for the assessment attitudes toward time. Time production of one-minute was measured three times in each of four sessions. Results. The tested participants of both groups shortened the one-minute intervals. Duration of anaesthesia did not affect the time production. Perceiving time as empty and meaningless was related with misestimating time after colonoscopy. Conclusions. Time interpretation by using metaphors and time production are related with each other.

Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) procedures in elderly patients are on the rise, and they play an important role in the diagnosis and management of various gastrointestinal diseases. The use of deep sedation in these patients has been established as a safe and effective technique in Western countries; however, it is uncertain if the situation holds true among Asians. The present study aimed to evaluate the age-dependent safety analysis and clinical efficacy of propofol-based deep sedation (PBDS) for ERCP and EUS procedures in adult patients at a World Gastroenterology Organization (WGO) Endoscopy Training Center in Thailand. Methods: We undertook a retrospective review of anesthesia or sedation service records of patients who underwent ERCP and EUS procedures. All procedures were performed by staff endoscopists, and all sedations were administered by anesthesia personnel in the endoscopy room. Results: PBDS was provided for 491 ERCP and EUS procedures. Of these, 252 patients (mean age, 45.1 ± 11.1 years, range 17-65 years) were in the ,65 age group, 209 patients (mean age, 71.7 ± 4.3 years, range 65-80 years) were in the 65-80 year-old group, and 30 patients (mean age, 84.6 ± 4.2 years, range 81-97 years) were in the .80 age group. Common indications for the procedures were pancreatic tumor, cholelithiasis, and gastric tumor. Fentanyl, propofol, and midazolam were the most common sedative drugs used in all three groups. The mean doses of propofol and midazolam in the very old patients were relatively lower than in the other groups. The combination of propofol, midazolam, and fentanyl, as well as propofol and fentanyl, were frequently used in all patients. Sedation-related adverse events and procedure-related complications were not statistically significantly different among the three groups. Hypotension was the most common complication. Conclusion: In the setting of the WGO Endoscopy Training Center in a developing country, PBDS for ERCP and EUS procedures in elderly patients by trained anesthesia personnel with appropriate monitoring is relatively safe and effective. Although adverse cardiovascular events, including hypotension, in this aged group is common, all adverse events were usually transient, mild, and easily treated, with no sequelae.

AIM:􀀃􀀷􀁒􀀃 􀁆􀁒􀁐􀁓􀁄􀁕􀁈􀀃 􀁄􀁑􀁇􀀃 􀁈􀁙􀁄􀁏􀁘􀁄􀁗􀁈􀀃 􀁗􀁋􀁈􀀃 􀁆􀁏􀁌􀁑􀁌􀁆􀁄􀁏􀀃 􀁈􀁉􀂿􀁆􀁄􀁆􀁜􀀃 􀁒􀁉􀀃 􀁄􀁑􀁈􀁖􀁗􀁋􀁈􀁗􀁌􀁆􀀃
trainee-administered propofol deep sedation (PDS) by using a syringe pump for small bowel enteroscopy (SBE) procedure between patients aged<65 years and patients aged􀄱65 years in an endoscopic unit outside operating room in Thailand.
METHODS: We undertook a retrospective review of SBE
􀁓􀁕􀁒􀁆􀁈􀁇􀁘􀁕􀁈􀁖􀀑􀀃 􀀳􀁄􀁗􀁌􀁈􀁑􀁗􀁖􀀃 􀁚􀁈􀁕􀁈􀀃 􀁆􀁏􀁄􀁖􀁖􀁌􀂿􀁈􀁇􀀃 􀁌􀁑􀁗􀁒􀀃 􀁗􀁚􀁒􀀃 􀁊􀁕􀁒􀁘􀁓􀁖􀀝􀀃 􀁊􀁕􀁒􀁘􀁓􀀃􀀤􀀃 􀀋􀁄􀁊􀁈􀀃 < 65 years) and group B (age 􀄱65 years). The primary outcome variable of the study was the successful completion of procedure. Secondary outcome variables were sedation-related complications during and immediately after the procedure.
RESULTS: After matching the patients’ characteristics, duration and indications of procedure, there were 45 patients in group A 􀁄􀁑􀁇􀀃 􀀕􀀛􀀃 􀁓􀁄􀁗􀁌􀁈􀁑􀁗􀁖􀀃 􀁌􀁑􀀃 􀁊􀁕􀁒􀁘􀁓􀀃 􀀥􀀑􀀃􀀷􀁋􀁈􀁕􀁈􀀃 􀁚􀁈􀁕􀁈􀀃 􀁑􀁒􀀃 􀁖􀁌􀁊􀁑􀁌􀂿􀁆􀁄􀁑􀁗􀀃 􀁇􀁌􀁉􀁉􀁈􀁕􀁈􀁑􀁆􀁈􀁖􀀃 in characteristics of patients, duration of procedure and indications of procedure between the two groups. All sedations were used 􀁖􀁘􀁆􀁆􀁈􀁖􀁖􀁉􀁘􀁏􀁏􀁜􀀃􀁈􀁛􀁆􀁈􀁓􀁗􀀃􀁒􀁑􀁈􀀃􀁓􀁄􀁗􀁌􀁈􀁑􀁗􀀃􀁌􀁑􀀃􀁊􀁕􀁒􀁘􀁓􀀃􀀤􀀑􀀃􀀷􀁋􀁈􀁕􀁈􀀃􀁚􀁈􀁕􀁈􀀃􀁑􀁒􀀃􀁖􀁌􀁊􀁑􀁌􀂿􀁆􀁄􀁑􀁗􀀃 differences in overall, respiratory and cardiovascular-related complications between the two groups. However, hypotension in 􀁊􀁕􀁒􀁘􀁓􀀃􀀥􀀃􀁚􀁄􀁖􀀃􀁖􀁌􀁊􀁑􀁌􀂿􀁆􀁄􀁑􀁗􀁏􀁜􀀃􀁋􀁌􀁊􀁋􀁈􀁕􀀃􀁗􀁋􀁄􀁑􀀃􀁌􀁑􀀃􀁊􀁕􀁒􀁘􀁓􀀃􀀤􀀑
CONCLUSION: In the setting of endoscopy unit outside operating room, PDS by anesthetic trainee using a syringe pump for SBE procedure in elderly patients with appropriate monitoring was 􀁕􀁈􀁏􀁄􀁗􀁌􀁙􀁈􀁏􀁜􀀃 􀁖􀁄􀁉􀁈􀀃 􀁄􀁑􀁇􀀃 􀁈􀁉􀁉􀁈􀁆􀁗􀁌􀁙􀁈􀀑􀀃 􀀦􀁏􀁌􀁑􀁌􀁆􀁄􀁏􀀃 􀁈􀁉􀂿􀁆􀁄􀁆􀁜􀀃 􀁒􀁉􀀃 􀁗􀁋􀁌􀁖􀀃 􀁗􀁈􀁆􀁋􀁑􀁌􀁔􀁘􀁈􀀃 􀁌􀁑􀀃 elderly patients was not different or worse than in younger patients.
However, the rate of hypotension was significantly high in the elderly patients than younger patients. Serious complications were rare.