Anesthesia for Patients Undergoing Peroral Endoscopic Myotomy Procedures: A Review of the Literature
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Anesthesia for Patients Undergoing Peroral Endoscopic Myotomy Procedures: A Review of the Literature. / Löser, Benjamin; Recio Ariza, Olga; Saugel, Bernd; Reuter, Daniel A; Zöllner, Christian; Werner, Yuki B; Rösch, Thomas; Petzoldt, Martin.
In: ANESTH ANALG, Vol. 130, No. 5, 05.2020, p. 1331-1340.Research output: SCORING: Contribution to journal › SCORING: Review article › Research
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TY - JOUR
T1 - Anesthesia for Patients Undergoing Peroral Endoscopic Myotomy Procedures: A Review of the Literature
AU - Löser, Benjamin
AU - Recio Ariza, Olga
AU - Saugel, Bernd
AU - Reuter, Daniel A
AU - Zöllner, Christian
AU - Werner, Yuki B
AU - Rösch, Thomas
AU - Petzoldt, Martin
PY - 2020/5
Y1 - 2020/5
N2 - Idiopathic achalasia is a motility disorder of the esophagus with important implications on anesthesia and periprocedural management. As new and more complex treatment options develop, anesthesiologists are increasingly involved with these patients. The cardinal symptoms of achalasia are as follows: dysphagia, regurgitation, chest pain, and weight loss. Achalasia is also associated with an increased risk of aspiration. Patients are frequently treated by endoscopic botulinum toxin injections, pneumatic dilation of the lower esophageal sphincter, laparoscopic Heller myotomy, or peroral endoscopic myotomy (POEM). The POEM procedure is based on the concept of "natural orifice transluminal endoscopic surgery." Because the integrity of the esophageal wall is deliberately interrupted during POEM, the mediastinum and the peritoneal cavity may be exposed. Thus, the insufflated carbon dioxide frequently causes hypercapnia, tension capnoperitoneum, capnomediastinum, or pneumothoraces. An interdisciplinary team, skilled in diagnostics and emergency measures such as therapeutic hyperventilation, percutaneous abdominal needle decompression, or pleural drainage, is essential for the successful periprocedural management of POEM. POEM is one endoscopic procedure that requires general anesthesia. But neither anesthesia-specific care algorithms nor evidence-based recommendations are currently available for these patients. Because institutional experience varies broadly across the globe, this review examines anesthesia recommendations and perioperative management of POEM procedures based on 7 retrospective case series, 1 prospective study, and our personal experience.
AB - Idiopathic achalasia is a motility disorder of the esophagus with important implications on anesthesia and periprocedural management. As new and more complex treatment options develop, anesthesiologists are increasingly involved with these patients. The cardinal symptoms of achalasia are as follows: dysphagia, regurgitation, chest pain, and weight loss. Achalasia is also associated with an increased risk of aspiration. Patients are frequently treated by endoscopic botulinum toxin injections, pneumatic dilation of the lower esophageal sphincter, laparoscopic Heller myotomy, or peroral endoscopic myotomy (POEM). The POEM procedure is based on the concept of "natural orifice transluminal endoscopic surgery." Because the integrity of the esophageal wall is deliberately interrupted during POEM, the mediastinum and the peritoneal cavity may be exposed. Thus, the insufflated carbon dioxide frequently causes hypercapnia, tension capnoperitoneum, capnomediastinum, or pneumothoraces. An interdisciplinary team, skilled in diagnostics and emergency measures such as therapeutic hyperventilation, percutaneous abdominal needle decompression, or pleural drainage, is essential for the successful periprocedural management of POEM. POEM is one endoscopic procedure that requires general anesthesia. But neither anesthesia-specific care algorithms nor evidence-based recommendations are currently available for these patients. Because institutional experience varies broadly across the globe, this review examines anesthesia recommendations and perioperative management of POEM procedures based on 7 retrospective case series, 1 prospective study, and our personal experience.
KW - Digestive System Surgical Procedures/methods
KW - Endoscopy, Gastrointestinal/methods
KW - Esophageal Achalasia/diagnostic imaging
KW - Humans
KW - Myotomy/methods
U2 - 10.1213/ANE.0000000000004420
DO - 10.1213/ANE.0000000000004420
M3 - SCORING: Review article
C2 - 31517673
VL - 130
SP - 1331
EP - 1340
JO - ANESTH ANALG
JF - ANESTH ANALG
SN - 0003-2999
IS - 5
ER -