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. CONCLUSION: PEG placement can be performed safely in patients with ALS with FVC <50% using NAPS with BiPAP.

Nurse-administered propofol sedation is safe for patients with obstructive sleep apnea undergoing routine endoscopy: a pilot study.

BACKGROUND: Nurse-administered propofol sedation (NAPS) is now in widespread use. The safety profile of NAPS for routine endoscopic procedures in patients with obstructive sleep apnea (OSA) is unknown. AIMS: To compare outcomes of patients with and without OSA undergoing routine endoscopic procedures with NAPS and standard conscious sedation (CS) with benzodiazepines and narcotics. METHODS: Retrospective cohort study. RESULTS: A total of 215 patients were placed in one of four groups: OSA patients undergoing endoscopy with NAPS, OSA patients undergoing endoscopy with standard CS, non-OSA patients undergoing endoscopy with NAPS, and non-OSA patients undergoing endoscopy with standard CS. Procedures were generally accomplished faster with NAPS. There was no statistically significant difference in complication rates or overall outcomes in patients with OSA when compared to non-OSA patients when either NAPS or CS was utilized. CONCLUSIONS: Routine endoscopic procedures using NAPS are safe in patients with documented OSA, with complication rates comparable to when using CS. NAPS helped to decrease procedure times in general.