Effect of Moderate Sedation Versus Deep Sedation on Recovery Following Outpatient Gastroscopy in Older Patients: A Randomized Controlled Trial

Abstract

Abstract Background Although gastrointestinal endoscopy with sedation is being increasingly performed in older patients, the appropriate level of sedation remains unclear. This study compared the effect of moderate sedation (MS) and deep sedation (DS) on recovery following outpatient gastroscopy in older patients. Methods In this randomized, partly blinded, controlled trial, 270 patients older than 60 years scheduled for elective outpatient gastroscopy were randomly divided into MS or DS group according to Modified Observer’s Assessment of Alertness/Sedation (MOAA/S). The primary outcome was the post-anesthesia care unit (PACU) stay time. Secondary outcomes include total hospital stay time, the incidence of retching, bucking, and body movements during the examination, the endoscopist and patient satisfaction, and sedation-associated adverse events during procedure. Results A total of 264 patients completed the study, of whom 131 received MS, and 133 received DS. MS was associated with a shorter PACU stay time [15.83 ± 8.69 min vs. 19.28 ± 9.70 min, P༜0.001] and total hospital stay time[30.37 ± 8.99 min vs. 34.02 ± 12.16min, P༜0.001], lesser hypoxemia [2.3% (3/131) vs. 12.8% (17/133), P = 0.014], use of fewer vasoactive drugs (P༜0.001) and more retching (P༜0.001). There was no difference in the incidence of bucking and body movements and endoscopist and patient satisfaction between two groups. Conclusion MS may be a better option for older patients undergoing outpatient gastroscopies, as demonstrated by shorter PACU stay time and total hospital stay time, lower sedation-associated adverse events, equal endoscopist and patient satisfaction. Trial registration Chinese Clinical Trial registration number ChiCTR2100049180. Registered 24/07/2021.