[Anesthetic management of elderly patients during percutaneous endoscopic gastrostomy].

OBJECTIVE: To evaluate anesthetic techniques for elderly patients during percutaneous endoscopic gastrostomy (PEG).

METHODS: Clinical data about 5 cases aged 80 years or more undergoing PEG from June 2012 to May 2013 in Chinese People's Liberation Army General Hospital were retrospectively analyzed and literature review.

RESULTS: Analgesia/minimal sedation combined with local anesthesia (LA including throat spray and operative site infiltrated ) is employed in the one of patients with Tracheoesophageal Fistula (TEF), for the remaining patients, analgesia/deep sedation and LA combination were used, during induction, temporary respiratory depression, blood pressure and heart rate decreased occurred respectively in the different patient, assisted ventilation and ephedrine IV was effective, the anesthesia strategy was to maintain a desired sedation with propofol or etomidate intravenously in small increments or by adjusted infusion , and to keep SpO2 at 95% or more with a supplemental oxygen through face mask under spontaneous ventilation. During the therapeutic period, an increase in blood pressure (BP) and heart rate (HR), slight cough occurred in one patient. Of all cases undergoing this procedure uneventfully and recovering well at the end of surgery without aspiration, asthma or airway obstruction, 4 were placed with jejunal feeding tube successfully, the mean duration of surgery is 80 min, ranging between 40 and 150 min, no anesthesia-related or cardiorespiratory complications occurred at follow-up.

CONCLUSIONS: a combination of intravenous sedative/analgesic anesthesia with LA is efficiently and safely suited to the patients at advanced age during PEG, for anesthesiologists, it should be the most important tenets of anesthetic practice to have preanesthetic evaluation well done about cardiorespiratory function and the ability of individual cooperation with anesthesia providers, to control airway and to manage circulatory system intraoperatively.