The periprocedural respiratory safety of propofol sedation in patients with a motor neuron disease undergoing percutaneous endoscopic gastrostomy insertion

• Published in: Journal of the neurological sciences Vol. 461; p. 123049
• Main Authors: van Neerven, Giel J.L., Schelling, Willem-Jan, van den Borne, Katrien, Bijleveld, Kim, Baars, Arlinda, Flink, Hajo, Gilissen, Lennard P.L.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.06.2024
• Subjects: Aged; Aged, 80 and over; ALS; Enteral Nutrition - adverse effects; Enteral Nutrition - methods; Female; Gastrostomy; Gastrostomy - adverse effects; Gastrostomy - methods; Humans; Hypnotics and Sedatives - adverse effects; Male; Middle Aged; Motor Neuron Disease; Motor neuron diseases; PEG; Pneumonia, Aspiration - etiology; Propofol; Propofol - administration & dosage; Propofol - adverse effects; Propofol - therapeutic use; Retrospective Studies; Gastrostomy; CHE; MND; PMA; SpO2; ALS; 95%-CI; BiPAP; NHF; ASA; FVC; PEG; Motor neuron diseases; PLS; (S)AE; NIV; Propofol; SP; BMI
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2024.123049

Motor neuron diseases (MND), such as Amyotrophic Lateral Sclerosis (ALS) and Primary Lateral Sclerosis (PLS), may cause swallowing and respiratory problems, due to muscle weakness. Chronic enteral feeding via percutaneous endoscopic gastrostomy (PEG) is often indicated in these patients. PEG insertion is normally performed with sedation. Some guidelines withhold sedation in MND patients, due to the risk of respiratory complications. These guidelines seem to be defensive however and evidence is lacking. Our aim was to examine periprocedural respiratory complications occurring in MND patients undergoing PEG insertion with propofol sedation. A retrospective monocentre study was conducted in a referral hospital with an experienced PEG team. Patients with MND who underwent PEG insertion with propofol sedation between January 1. 2016 to January 1. 2023 were analysed to identify periprocedural respiratory complications. 46 patients were included. In five patients (10.9%) respiratory adverse events (AE) occurred, of which two serious (4.3%) and four AE (8.7%). Serious AE (SAE) were fatal in both cases: aspiration pneumonia (2.2%) and hypercapnia (2.2%) a few days after insertion. Sedation may have influenced the first case. Respiratory AE consisted of desaturation in two (4.3%), mild aspiration pneumonia in one (2.2%), and apnea in one patient (2.2%). Compared to previous studies respiratory complications and mortality had comparable prevalences. •Propofol sedation during PEG insertion in MND patients does not increase the prevalence of periprocedural respiratory complications compared to literature.•Guidelines seem to be defensive on the use of (propofol) sedation during PEG insertion in MND patients, as the current literature shows.•A multidisciplinary approach of PEG insertion in MND patients by an experienced team is advised.