An Oxycodone-Based Conscious Analgesia Strategy with Supplemental Low-Dose Propofol Improves Safety in Elderly Obese Patients Undergoing Gastroscopy: A Prospective Randomized Controlled Trial.

BACKGROUND: During diagnostic gastroscopy, intolerance is usually manifested as retching, coughing, and involuntary movement. Conscious analgesia relieves discomfort while patients continue to breathe spontaneously and remain partly responsive. Oxycodone, a semi-synthetic opioid, may reduce the need for deep propofol sedation. We compared an oxycodone-based conscious analgesia strategy with supplemental low-dose propofol with propofol-based deep sedation in elderly obese patients. PATIENTS AND METHODS: In this prospective, single-center, open-label randomized controlled trial, 128 patients aged ≥65 years with a body mass index of 30-39.9 kg/m2 undergoing elective gastroscopy were randomized 1:1 to propofol-based deep sedation (group P) or oxycodone-based conscious analgesia with supplemental low-dose propofol (group OP). The primary outcome was the incidence of hypoxemia, defined as any SpO2 reading <90% during the procedure. Key secondary outcomes were airway interventions, hypotension, propofol consumption, and recovery time. RESULTS: All 128 randomized patients completed the study. Hypoxemia occurred less frequently in group OP than in group P (10.94% vs 37.50%; relative risk, 0.29; 95% CI, 0.14-0.63; P<0.001). Group OP also required fewer airway interventions (10.94% vs 37.50%; P<0.001), and mask-assisted ventilation was required less often (1.56% vs 32.81%; P<0.001). Hypotension was less frequent (9.38% vs 28.13%; P=0.012), total propofol consumption was lower (0.38±0.13 vs 1.70±0.25 mg/kg; P<0.001), and time to full wakefulness was shorter (3.89±0.73 vs 8.21±1.12 minutes; P<0.001) in group OP. CONCLUSION: Compared with propofol-based deep sedation, the oxycodone-based conscious analgesia strategy was associated with a lower incidence of hypoxemia, fewer airway interventions, less hypotension, lower propofol exposure, and faster recovery. These findings reflect a comparison of two sedation strategies and do not establish improved respiratory function.