Anesthetic management and associated complications of peroral endoscopic myotomy: A case series

Yuuki Nishihara, Takuya Yoshida, Mayu Ooi, Norihiko Obata, Shinichiro Izuta, Satoshi Mizobuchi, Yuuki Nishihara, Takuya Yoshida, Mayu Ooi, Norihiko Obata, Shinichiro Izuta, Satoshi Mizobuchi

Abstract

Aim: To investigate the anesthetic management of peroral endoscopic myotomy (POEM) and its associated complications.

Methods: This study was a single-center, retrospective, observational study comprising a case series of all patients who underwent POEM in our hospital from April 2015 to November 2016. We collected data regarding patient characteristics, anesthetic methods, surgical factors, and complications using an electronic chart.

Results: There were 86 patients who underwent POEM in our hospital during the study period. Preoperatively, patients were maintained on a low residue diet for 48 h prior to the procedure. They were fasted of solids for 24 h before surgery. There was one case of aspiration (1.2%). During POEM, patients were positioned supine with the upper abdomen covered by a clear drape so that pneumoperitoneum could be timeously identified. In three cases, the peak airway pressure exceeded 35 cmH2O during volume controlled ventilation with tidal volumes of 6-8 mL/kg and subsequent impairment of ventilation. These cases had been diagnosed with spastic esophageal disorders (SEDs) and the length of the muscular incision on the esophageal side was longer than normal.

Conclusion: In the anesthetic management of POEM, it is important to prevent aspiration during induction of anesthesia and to identify and treat complications associated with CO2 insufflation.

Keywords: Anesthetic management; Peroral endoscopic myotomy; Ventilatory impairment.

Conflict of interest statement

Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.

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