The Comparison of Deep Sedation and Moderate Sedation in Pneumatic Balloon Dilation of Achalasia Patients

Javad Mikaeli; Narges Fazlollahi; Alireza Khajehnasiri; Zahra Tamartash; Reza  Atef-Yekta

doi:10.18502/aacc.v9i5.13964

Javad Mikaeli Autoimmune and Motility Disorders Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Narges Fazlollahi Autoimmune and Motility Disorders Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Alireza Khajehnasiri Department of Anaesthesiology, Intensive care, and Pain, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Zahra Tamartash Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Reza Atef-Yekta Department of Anaesthesiology, Intensive care, and Pain, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/aacc.v9i5.13964

Keywords: Achalasia; Deep sedation; Moderate sedation

Abstract

Background: Pneumatic Balloon Dilation (PBD) as an achalasia treatment is painful procedure because of tearing the lower esophageal sphincter (LES) muscle fibres. Recently, two sedation methods including the moderate sedation and deep sedation are used for increasing the convenience of the patients and gastroenterologist.

Methods: To compare the efficacy of moderate and deep sedation in PBD in treatment of Idiopathic Achalasia (IA).

Results: We prospectively assessed 200 IA patients. The first 100 patients (group A) underwent PBD by the moderate sedation using diazepam or midazolam and meperidine injections. The patients in the group B (100 patients) received midazolam, fentanyl and propofol as a deep sedation. The pulse rate (PR), systolic and diastolic blood pressure (SBP, DBP), respiratory rate (RR), and oxygen saturation were monitored before, during and after PBD and achalasia symptom scores (ASS) were collected before and 1.5 months after treatment. The mean PR during and after procedures in the group B were significantly lower compared to the group A (p 0.001, 0.028). The patients in group B revealed less SBP and DBP after PBD versus group A (p 0.004, 0.002). The mean psi for 30 mm and 35 mm balloon dilators were significantly increased in group B compared to group (p 0.0001, 0.002).

Conclusion: We concluded that the deep sedation of achalasia patients in the PBD process can improved the efficacy of PBD and decreased the complications (transient chest pain) of the procedures. The patients with the deep sedation revealed less tachycardia and blood pressure rising and tolerated more pressure in balloon dilators.