A retrospective study of nurse-assisted propofol sedation in patients with amyotrophic lateral sclerosis undergoing percutaneous endoscopic gastrostomy.
BACKGROUND
Percutaneous endscopic gastrostomy (PEG) placement is standard in the care of patients with amyotrophic lateral sclerosis (ALS) unable to maintain adequate oral nutrition. This has been performed using conscious sedation with narcotics/benzodiazepines. However, recent studies suggest that propofol sedation is superior for other endoscopic procedures. In addition, endoscopic PEG placement is not recommended for patients with ALS with a forced vital capacity (FVC) <50%. The authors postulated that nurse-administered propofol sedation (NAPS) with the addition of bilevel positive airway pressure (BiPAP) would be superior to standard sedation with midazolam/fentanyl (M/F) in all patients with ALS regardless of FVC. Here the authors review their retrospective experience of PEG placements in patients with ALS using propofol ± BiPAP vs traditional sedation ± BiPAP.


RESULTS
Thirty-one patients received M/F, and 29 received NAPS. BiPAP was used more often in the NAPS group (24/29 NAPS vs 6/31 M/F respectively, P < .0001). Twenty-nine of 31 PEG placements in the M/F group and 27 of 29 PEG placements in the NAPS group were successful. Seven desaturation events occurred to <90% in the M/F group compared with 1 desaturation event in the NAPS group (P = .05). No other complications were noted.


CONCLUSIONS
PEG placement can be performed safely in patients with ALS with FVC <50% using NAPS with BiPAP.
University Hospitals Case Medical Center, Cleveland, OH, USA.
Chad
C
Kawa
James
J
Stewart
Kristen
K
Hilden
Douglas G
DG
Adler
Christopher
C
Tietze
Mark B
MB
Bromberg
John C
JC
Fang
D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000601:surgery*; D000758:Anesthesia; D016292:Procedural Sedation / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D009726:Nurses; D015742:Propofol / Q000008:administration & dosage; D012189:Retrospective Studies; D014797:Vital Capacity
D008874:Midazolam; D005283:Fentanyl; D015742:Propofol