Abstract
Peroral endoscopic myotomy (POEM) is a newly developed, less invasive treatment for esophageal achalasia that requires general anesthesia under positive pressure ventilation. In this retrospective case series, we describe the anesthetic management of 28 consecutive patients who underwent POEM for esophageal achalasia. Anesthesia was maintained with sevoflurane and remifentanil under positive pressure ventilation through a tracheal tube. Retained contents in the esophagus were evacuated just before anesthesia induction to prevent regurgitation into the trachea. The POEM procedure was performed using an orally inserted flexible fiberscope. Elevation of end-tidal carbon dioxide after initiating esophageal carbon dioxide insufflation was observed in all patients and was treated by minute adjustments to the ventilation volume. Scopolamine butylbromide-induced tachycardia in one patient was treated with landiolol hydrochloride, which is a short-acting beta 1-selective blocker. Minor subcutaneous emphysema around the neck was observed in one patient. POEM was successfully completed, and tracheas were extubated immediately after the procedure in all patients. Our findings suggest that prevention of aspiration pneumonia during anesthesia induction, preparation for carbon dioxide insufflation-related complications, and treatment of scopolamine butylbromide-induced tachycardia play important roles in safe anesthesia management of POEM for esophageal achalasia.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ferguson MK. Achalasia: current evaluation and therapy. Ann Thorac Surg. 1991;52:336–42.
Bedgood R, Sadurski R, Schade RR. The use of the internet in data assimilation in rare diseases. Dig Dis Sci. 2007;52:307–12.
Bello B, Herbella FA, Patti MG. Evolution of the minimally invasive treatment of esophageal achalasia. World J Surg. 2011;35:1442–6.
Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, Magee CA, Kantsevoy SV. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc. 2004;60:114–7.
Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H, Kudo S. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265–71.
Inoue H, Tianle KM, Ikeda H, Hosoya T, Onimaru M, Yoshida A, Minami H, Kudo SE. Peroral endoscopic myotomy for esophageal achalasia: technique, indication, and outcomes. Thorac Surg Clin. 2011;21:519–25.
von Renteln D, Inoue H, Minami H, Werner YB, Pace A, Kersten JF, Much CC, Schachschal G, Mann O, Keller J, Fuchs KH, Rosch T. Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study. Am J Gastroenterol. 2012;107:411–7.
Minami H, Isomoto H, Yamaguchi N, Matsushima K, Akazawa Y, Ohnita K, Takeshima F, Inoue H, Nakao K. Peroral endoscopic myotomy for esophageal achalasia: Clinical impact of 28 cases. Dig Endosc 2013. doi:10.1111/den.12086
Khandelwal M, Krueger C. Diaphragmatic hernia after laparoscopic esophagomyotomy for esophageal achalasia in pregnancy. ISRN Gastroenterol 2011;2011:871958. doi:10.5402/2011/871958
Kohjitani A, Shirakawa J, Satoh E, Kagawa T, Nakajima M, Obara H. Effects of sevoflurane and enflurane on lower esophageal sphincter pressure and gastroesophageal pressure gradient in children. J Anesth. 1999;13:1–7.
Turan A, Wo J, Kasuya Y, Govinda R, Akca O, Dalton JE, Sessler DI, Rauch S. Effects of dexmedetomidine and propofol on lower esophageal sphincter and gastroesophageal pressure gradient in healthy volunteers. Anesthesiology. 2010;112:19–24.
Swanstrom LL, Rieder E, Dunst CM. A stepwise approach and early clinical experience in peroral endoscopic myotomy for the treatment of achalasia and esophageal motility disorders. J Am Coll Surg 2011;213:751–56.
Ren Z, Zhong Y, Zhou P, Xu M, Cai M, Li L, Shi Q, Yao L. Perioperative management and treatment for complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA) (data from 119 cases). Surg Endosc 2012;26:3267–72.
Costamagna G, Marchese M, Familiari P, Tringali A, Inoue H, Perri V. Peroral endoscopic myotomy (POEM) for oesophageal achalasia: Preliminary results in humans. Dig Liver Dis 2012;4:827–32.
Lindsey S. Subcutaneous carbon dioxide emphysema following laparoscopic salpingo-oophorectomy: a case report. AANA J. 2008;76:282–5.
Grainger SL, Smith SE. Dose-response relationships of intravenous hyoscine butylbromide and atropine sulphate on heart rate in healthy volunteers. Br J Clin Pharmacol. 1983;16:623–6.
Suzuki S, Nonaka A, Abe F. Effect of esmolol on cardiovascular responses induced by scopolamine butylbromide. Masui. 2005;54:1277–81.
Katoh K, Nomura M, Iga A, Hiasa A, Uehara K, Harada K, Nakaya Y, Ito S. Comparison of gastric peristalsis inhibition by scopolamine butylbromide and glucagon: evaluation by electrogastrography and analysis of heart rate variability. J Gastroenterol. 2003;38:629–35.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Tanaka, E., Murata, H., Minami, H. et al. Anesthetic management of peroral endoscopic myotomy for esophageal achalasia: a retrospective case series. J Anesth 28, 456–459 (2014). https://doi.org/10.1007/s00540-013-1735-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-013-1735-0