Introduction All patients with head and neck cancer referred for nutritional support with enteral feeding to our unit undergo direct puncture gastropexy placement as per the British Society of Gastroenterology guidelines published in 20101. On introduction of the new technique we observed that standard sedation with intravenous pethidine and midazolam often led to patients tolerating the procedures poorly and occasionally to the procedures being abandoned. Therefore a decision was made to continue these procedures with ‘deep’ sedation supervised with a consultant anaesthetist using remifentanil, midazolam and diamorphine. We present our data for the 18months until January 2013 using deep sedation.
Methods The details of all patients attending for gastropexy procedures in East Kent between June 2011 and 11th January 2013 were reviewed to assess the type of sedation used, patient comfort (measured using the modified Gloucester score and assessed by the endoscopy nursing staff post-procedure) and complications.
Results 35 patients (M: 31, F: 10, mean age 61, range 43yrs- 72yrs) underwent gastropexy procedures under deep sedation.
The mean time taken to perform the procedure under deep sedation was 23.3 minutes +/- standard deviation of 4.6minutes. Range from 14–29 minutes.
A total of 27 patients reported no discomfort and were resting comfortably throughout the procedure. 4 cases recorded to have experienced one or two episodes of mild discomfort but had tolerated the procedure well and 4 cases of minimal discomfort were reported, again the procedure was well tolerated. There were no reported complications (immediate or late).
Conclusion Patients with head and neck cancers undergoing gastropexy procedures tolerate these procedures far better under deep sedation. We would recommend that such an approach improves the welfare of our patients and recommend its use to colleagues.
Disclosure of Interest None Declared.
Westaby et al. The Provision of a Percutaneously Placed Enteral Feeding Tube Service. Gut 2010; 59: 1592- 1605