Case Control Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2018; 10(9): 193-199
Published online Sep 16, 2018. doi: 10.4253/wjge.v10.i9.193
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, Department of Anesthesiology, Kobe University Hospital, Kobe 650-0017, Japan
Satoshi Mizobuchi, Division of Anesthesiology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
Author contributions: Nishihara Y, Yoshida T and Obata N designed research; Nishihara Y and Yoshida T collected data and drafted the manuscript; Ooi M, Izuta S and Mizobuchi S revised the manuscript for important intellectual content; Mizobuchi S supervised the study; all authors have read and approved the final version to be published.
Institutional review board statement: This study was reviewed and approved by Kobe University Hospital institutional Review Board.
Informed consent statement: All study participants provided informed written consent prior to study enrollment. The patients can share their perspective on their cases.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Takuya Yoshida, MD, Doctor, Department of Anesthesiology, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan. takuyayoshida47@gmail.com
Telephone: +81-78-3826172 Fax: +81-78-3826189
Received: May 2, 2018
Peer-review started: May 3, 2018
First decision: May 22, 2018
Revised: May 27, 2018
Accepted: June 30, 2018
Article in press: June 30, 2018
Published online: September 16, 2018
Processing time: 139 Days and 8.8 Hours
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: Peroral endoscopic myotomy; Anesthetic management; Ventilatory impairment

Core tip: In the anesthetic management of peroral endoscopic myotomy (POEM), it is important to identify and treat complications associated with CO2 insufflation. In this retrospective case series, we experienced three cases of ventilatory complications caused by CO2 insufflation. These cases had been diagnosed with spastic esophageal disorders and the length of the muscular incision on the esophageal side was longer than usual. In particular, pneumoperitoneum needs to be carefully assessed for during the procedure, especially when a longer muscular incision is necessary. Significantly, this is the first case series report of ventilatory impairment occurring as an anesthetic complication of POEM using CO2 insufflation.