ABSTRACT
Sedation in the elderly has recently been the subject of two publications from national authorities in the UK. The National Confi dential Enquiry into Patient Outcome and Death7 (NCEPOD) considered the cases of over 1800 inpatients who had been subject to an endoscopic gastrointestinal investigational procedure within 30 days before death. In 14% of cases the assessors considered that the sedation method that had been used was incorrect, usually due to excessive drug dosages. This most often involved the administration of an inappropriately large dose of benzodiazepine, or a smaller dose being administered too quickly. The use of fl umazenil to reverse the effects of benzodiazepine (an indication of inadvertent overdose) was associated with earlier death. Sadly, this fi nding was not new, as the association between dosage of benzodiazepine administered for sedation and death had been recognised nearly 10 years previously.8 In addition, it was found that the monitoring used was defi cient in 23% of cases considered, despite the fact that many of the patients who were undergoing procedures were unwell or undergoing emergency treatment.
