Procedural sedation in the elderly: a narrative review

Abstract

Background: There is a growing need for anaesthesia care tailored to elderly patients, particularly as more elderly individuals undergo medical procedures requiring anaesthesia. However, clinical trials focused explicitly on this demographic remain limited, with many prospective studies excluding elderly patients, hindering progress in identifying optimal anaesthesia practices for this group.

Objective: This narrative review aims to consolidate recent evidence on procedural sedation in elderly patients, focusing on the safety and efficacy of new and existing anaesthetic agents.

Method: A systematic search of EMBASE and MEDLINE was conducted, covering studies published between January 2000 and March 2024. The review included randomized controlled trials (RCTs), systematic reviews, and meta-analyses examining various sedation strategies for patients over 65 years old, assessing outcomes such as recovery time, perioperative cardiopulmonary adverse events, delirium, and cognitive dysfunction.

Results: The review provides an overview of various sedation strategies and their impact on elderly patients. Propofol offers faster onset and higher sedation success but carries a risk of adverse effects. Newer agents like remimazolam and dexmedetomidine show promising safety profiles, particularly in reducing cardiopulmonary adverse events and cognitive dysfunction. The combination of lidocaine and propofol for sedation in endoscopic procedures has shown promising results, allowing for lower propofol doses while retaining sedative efficacy and reducing hypoxia. High-flow nasal cannula (HFNC) oxygen therapy consistently shows a positive impact on oxygenation during gastrointestinal endoscopy.

Conclusion: This narrative review provides an overview of recent trials on procedural sedation in elderly patients, highlighting the need for further research to validate outcomes and guide improvements in geriatric anaesthesia care.