Abstract：
Peroral endoscopic myotomy (POEM) has proven to be a successful treatment method for achalasia in both adult and pediatric patients. Yet, there is a lack of evidence for anaesthetic management of pediatric patients who underwent POEM procedure. In this study, we aim to present perioperative and postoperative management strategies for pediatric patients with achalasia from in anaesthesia aspect.
Medical records were reviewed for 16 pediatric patients at a single center who underwent POEM procedure for achalasia between 2017 and 2020. Patients\' data regarding demographics, preoperative diet, body mass index, perioperative monitoring and vitals, airway management, anaesthesia maintenance, mechanical ventilation settings duration of recovery, length of stay, pain management and adverse events were evaluated.
The study cohort included 7 female and 9 male patients with a mean age of 5.5 years. Anaesthesia maintenance was provided with 0.8-1.2 minimum alveolar concentration sevoflurane in a 40-60% O2-air mixture, Remifentanil infusion and bolus doses of Rocuronium. The median age was 3 years for patients ventilated in pressure controlled ventilation mode and 10 years in volume controlled ventilation mode. Respiration rate and minute ventilation were adjusted to maintain end tidal carbon dioxide (ETCO2) below 45 mmHg. Needle decompression was applied for 14 patients (87.5%) for treatment of capnoperitoneum. The mean procedure duration and recovery room duration were 66 (±22.9) minutes and 62 (±21) minutes, respectively. Postoperative pain management is provided with paracetamol and tramadol in total 8 patients (50%). There was no adverse event during postoperative period and all patients discharged in a mean time of 3 days.
POEM has demonstrated encouraging outcomes in terms of safety and effectiveness in pediatric patients. Due to challenging nature of the pediatric patients, it is important to acknowledge that the procedure requires specialized anaesthesia management. Management of perioperative complications of increased ETCO2 requires understanding the physiologic results of pneumo-mediastinum and pneumo-peritoneum. Beside the known anaesthetic management strategies, a tailored approach should be adopted for each patient. Further investigations should be conducted to develop standardized management.
Medical records were reviewed for 16 pediatric patients at a single center who underwent POEM procedure for achalasia between 2017 and 2020. Patients\' data regarding demographics, preoperative diet, body mass index, perioperative monitoring and vitals, airway management, anaesthesia maintenance, mechanical ventilation settings duration of recovery, length of stay, pain management and adverse events were evaluated.
The study cohort included 7 female and 9 male patients with a mean age of 5.5 years. Anaesthesia maintenance was provided with 0.8-1.2 minimum alveolar concentration sevoflurane in a 40-60% O2-air mixture, Remifentanil infusion and bolus doses of Rocuronium. The median age was 3 years for patients ventilated in pressure controlled ventilation mode and 10 years in volume controlled ventilation mode. Respiration rate and minute ventilation were adjusted to maintain end tidal carbon dioxide (ETCO2) below 45 mmHg. Needle decompression was applied for 14 patients (87.5%) for treatment of capnoperitoneum. The mean procedure duration and recovery room duration were 66 (±22.9) minutes and 62 (±21) minutes, respectively. Postoperative pain management is provided with paracetamol and tramadol in total 8 patients (50%). There was no adverse event during postoperative period and all patients discharged in a mean time of 3 days.
POEM has demonstrated encouraging outcomes in terms of safety and effectiveness in pediatric patients. Due to challenging nature of the pediatric patients, it is important to acknowledge that the procedure requires specialized anaesthesia management. Management of perioperative complications of increased ETCO2 requires understanding the physiologic results of pneumo-mediastinum and pneumo-peritoneum. Beside the known anaesthetic management strategies, a tailored approach should be adopted for each patient. Further investigations should be conducted to develop standardized management.
摘要：
经口内镜肌切开术（POEM）已被证明是成人和儿童门失弛缓症的成功治疗方法。然而，对于接受POEM手术的儿科患者,目前缺乏麻醉管理的证据.在这项研究中,我们旨在从麻醉方面提出小儿贲门失弛缓症患者的围手术期和术后管理策略。
在2017年至2020年期间，在一个单一中心对16名接受POEM手术治疗贲门失弛缓症的儿科患者进行了病历审查。关于人口统计学的患者数据，术前饮食,身体质量指数,围手术期监测和生命体征，气道管理,麻醉维持,机械通气设置恢复持续时间，逗留时间,评估疼痛管理和不良事件.
研究队列包括7名女性和9名男性患者，平均年龄为5.5岁。在40-60％O2-空气混合物中，七氟醚的最低肺泡浓度为0.8-1.2，瑞芬太尼输注和推注剂量的罗库溴铵。在压力控制通气模式下通气的患者的中位年龄为3岁，在容量控制通气模式下通气的患者的中位年龄为10岁。调整呼吸速率和每分钟通气量以保持潮气末二氧化碳(ETCO2)低于45mmHg。对14例患者（87.5%）采用针管减压治疗腹膜。平均手术时间和恢复室时间分别为66（±22.9）分钟和62（±21）分钟，分别。共有8例患者（50％）使用对乙酰氨基酚和曲马多进行术后疼痛管理。术后期间无不良事件发生，所有患者平均出院时间为3天。
POEM在儿科患者的安全性和有效性方面表现出令人鼓舞的结果。由于儿科患者的挑战性，重要的是要承认该程序需要专门的麻醉管理。处理ETCO2升高的围手术期并发症需要了解肺纵隔和肺腹膜的生理结果。除了已知的麻醉管理策略，每个患者都应采用量身定制的方法。应进行进一步调查，以制定标准化管理。
在2017年至2020年期间，在一个单一中心对16名接受POEM手术治疗贲门失弛缓症的儿科患者进行了病历审查。关于人口统计学的患者数据，术前饮食,身体质量指数,围手术期监测和生命体征，气道管理,麻醉维持,机械通气设置恢复持续时间，逗留时间,评估疼痛管理和不良事件.
研究队列包括7名女性和9名男性患者，平均年龄为5.5岁。在40-60％O2-空气混合物中，七氟醚的最低肺泡浓度为0.8-1.2，瑞芬太尼输注和推注剂量的罗库溴铵。在压力控制通气模式下通气的患者的中位年龄为3岁，在容量控制通气模式下通气的患者的中位年龄为10岁。调整呼吸速率和每分钟通气量以保持潮气末二氧化碳(ETCO2)低于45mmHg。对14例患者（87.5%）采用针管减压治疗腹膜。平均手术时间和恢复室时间分别为66（±22.9）分钟和62（±21）分钟，分别。共有8例患者（50％）使用对乙酰氨基酚和曲马多进行术后疼痛管理。术后期间无不良事件发生，所有患者平均出院时间为3天。
POEM在儿科患者的安全性和有效性方面表现出令人鼓舞的结果。由于儿科患者的挑战性，重要的是要承认该程序需要专门的麻醉管理。处理ETCO2升高的围手术期并发症需要了解肺纵隔和肺腹膜的生理结果。除了已知的麻醉管理策略，每个患者都应采用量身定制的方法。应进行进一步调查，以制定标准化管理。
