Anesthetic strategy for percutaneous endoscopic gastrostomy in amyotrophic lateral sclerosis patients

Amyotrophic Lateral Sclerosis (ALS) is a kind of severe and lethal motor neuron disease, its clinical symptom including dysphasia, choking, cough, acataposis and different levels of limb-muscle and mastication weakness, which increase the difficulty and danger of anesthetic strategy for Percutaneous Endoscopic Gastrostomy (PEG) in ALS patients. In order to develop a better anesthesia procedure for PEG in ALS patients in this research, nine ASA II-III ALS patients were enrolled. Midazolam (1-2 mg), sufentanil (3-5 μg), propofol (1.5-2 mg/kg) and etomidate (0.2-0.3 mg/kg) were intravenously applied for anesthesia induction. The operation would be performed after the patients lost their consciousness and eyelash reflex, and could not respond to verbal command. The PEG tube placements were performed via the pull-through technique under anesthesia with endoscopic mask for oxygen inhalation and local anesthesia (2% lidocaine) at the site. Propofol (20-50 mg) was further applied as required. A special endoscopic mask for gastroscopy was used for oxygen inhalation. Blood pressure (BP), heart rate (HR), oxyhemoglobin saturation (SpO2), dosage of anesthetics, surgery duration, recovery duration and relative complications were recorded. From the results, we get that all patients successfully received PEG with well anesthesia. No cough, agitation or drastic fluctuations in BP, HR or SpO2 was observed during the procedures of all patients. No anesthesia-related complications were observed within 24 hours after PEG placement. One patient was transferred to ICU for breathing support due to the deteriorated condition or anesthesia .Therefore, with the help of small doses of midazolam, sufentanil, etomidate, propofol, and breathing support with a special endoscopic mask for gastroscopy, PEG can be safely and effectively performed in ALS patients.