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Cardiovascular dynamics during peroral endoscopic myotomy for esophageal achalasia: a prospective observational study using non-invasive finger cuff-derived pulse wave analysis

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Abstract

Peroral endoscopic myotomy (POEM) is natural orifice transluminal endoscopic surgery to treat esophageal achalasia. During POEM, cardiovascular dynamics can be impaired by capnoperitoneum, capnomediastinum, and systemic carbon dioxide accumulation. We systematically investigated changes in cardiovascular dynamics during POEM. We included 31 patients having POEM in this single-center prospective observational study. Before and every 5 min during POEM we measured mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), stroke volume index (SVI), and systemic vascular resistance index (SVRI) using non-invasive finger cuff-derived pulse wave analysis. During POEM, the median MAP was higher than the median baseline MAP of 77 (67;86) mmHg. HR (median at baseline: 67 (60;72) bpm), CI (2.8 (2.5;3.2) L/min/m2), SVI (42 (34;51) mL/m2), and SVRI (1994 (1652; 2559) dyn × s × cm−5 × m−2) remained stable during POEM. Mixed model-derived 95% confidence limits of hemodynamic variables during POEM were 72 to 106 mmHg for MAP, 65 to 79 bpm for HR, 2.7 to 3.3 L/min/m2 for CI, 37 and 46 mL/m2 for SVI, and 1856 and 2954 dyn × s × cm−5 × m−2 for SVRI. POEM is a safe procedure with regard to cardiovascular dynamics as it does not markedly impair MAP, HR, CI, SVI, or SVRI.

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Data are available from the authors upon reasonable request.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Bernd Saugel and Christina Vokuhl contributed equally.

Authors and Affiliations

  1. Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Bernd Saugel, Christina Vokuhl & Martin Petzoldt

  2. Outcomes Research Consortium, Cleveland, OH, USA

    Bernd Saugel

  3. Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Hans O. Pinnschmidt

  4. Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Thomas Rösch

  5. Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medicine Rostock, Schillingallee 35, 18057, Rostock, Germany

    Benjamin Löser

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  1. Bernd Saugel
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  2. Christina Vokuhl
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  3. Hans O. Pinnschmidt
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  4. Thomas Rösch
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  6. Benjamin Löser
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Contributions

BS: This author conceived and designed the study, was responsible for data analysis and interpretation, drafted the manuscript, and supervised the study. CV: This author collected the data, was responsible for data analysis and interpretation, and drafted the manuscript. HOP: This author was responsible for data analysis and interpretation, performed the statistical analyses, and critically revised the manuscript for important intellectual content. TR: This author was responsible for data analysis and interpretation and critically revised the manuscript for important intellectual content. MP: This author was responsible for data analysis and interpretation and critically revised the manuscript for important intellectual content. BL: This author conceived and designed the study, was responsible for data analysis and interpretation, and drafted the manuscript.

Corresponding author

Correspondence to Benjamin Löser.

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Conflict of interest

BS has received institutional restricted research grants, honoraria for giving lectures, and refunds of travel expenses from CNSystems Medizintechnik GmbH (Graz, Austria). For all other authors there is no conflict of interest to disclose.

Ethics approval

Ethical approval for this study (PV5540) was provided by the Ethics Committee of the Medical Board of Hamburg, Germany (Prof M. Carstensen) on 22 August 2017.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Electronic supplementary material

Glossary

POEM

Peroral endoscopic myotomy

ASA

American Society of Anesthesiologists

MAP

Mean arterial pressure

HR

Heart rate

CI

Cardiac index

SVI

Stroke volume index

SVRI

Systemic vascular resistance index

CO2

Carbon dioxide

etCO2

End-tidal carbon dioxide

MV

Minute ventilation

TV

Tidal volume

RR

Respiratory rate

PEAK

Peak inspiratory pressure

PEEP

Positive end-expiratory pressure

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Saugel, B., Vokuhl, C., Pinnschmidt, H.O. et al. Cardiovascular dynamics during peroral endoscopic myotomy for esophageal achalasia: a prospective observational study using non-invasive finger cuff-derived pulse wave analysis. J Clin Monit Comput 35, 827–834 (2021). https://doi.org/10.1007/s10877-020-00541-8

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  • DOI: https://doi.org/10.1007/s10877-020-00541-8

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