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Abstract：
OBJECTIVE: 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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
目的：探讨经口内镜下肌切开术(POEM)的麻醉处理及相关并发症。
方法：本研究是单中心，回顾性,观察性研究包括2015年4月至2016年11月在我院接受POEM的所有患者的病例系列。我们收集了有关患者特征的数据，麻醉方法,手术因素，和使用电子图表的并发症。
结果：在研究期间，有86例患者在我院接受了POEM。术前,患者在手术前保持低残留饮食48小时.他们在手术前禁食固体24小时。有一例误吸（1.2%）。在POEM期间，患者仰卧位，上腹部被清晰的悬垂物覆盖，以便可以及时识别气腹。在三种情况下，在容量控制通气(潮气量为6~8mL/kg)和随后的通气损害期间,气道峰值压力超过35cmH2O.这些病例已被诊断为痉挛性食管疾病（SED），并且食管侧肌肉切口的长度比正常人长。
结论：在POEM的麻醉管理中，重要的是在麻醉诱导期间防止误吸,以及识别和治疗与CO2吹入相关的并发症.
方法：本研究是单中心，回顾性,观察性研究包括2015年4月至2016年11月在我院接受POEM的所有患者的病例系列。我们收集了有关患者特征的数据，麻醉方法,手术因素，和使用电子图表的并发症。
结果：在研究期间，有86例患者在我院接受了POEM。术前,患者在手术前保持低残留饮食48小时.他们在手术前禁食固体24小时。有一例误吸（1.2%）。在POEM期间，患者仰卧位，上腹部被清晰的悬垂物覆盖，以便可以及时识别气腹。在三种情况下，在容量控制通气(潮气量为6~8mL/kg)和随后的通气损害期间,气道峰值压力超过35cmH2O.这些病例已被诊断为痉挛性食管疾病（SED），并且食管侧肌肉切口的长度比正常人长。
结论：在POEM的麻醉管理中，重要的是在麻醉诱导期间防止误吸,以及识别和治疗与CO2吹入相关的并发症.
