Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan.
Curr Opin Anaesthesiol. 2019 Aug;32(4):511-516. doi: 10.1097/ACO.0000000000000742.
Peroral endoscopic myotomy (POEM) was developed in Japan as a less invasive treatment for esophageal achalasia requiring general anesthesia under positive pressure ventilation. In 2018, the Japan Gastroenterological Endoscopy Society published the first guidelines describing the standard care for POEM. Based on these guidelines, we discuss the typical approach to anesthesia during POEM for the management of esophageal achalasia in Japan.
Prior cleansing of the esophagus is essential to prevent both aspiration during induction of anesthesia and contamination of the mediastinum and thoracic/abdominal cavity by esophageal remnants after endoscopic resection of the esophageal mucosa. Although rare, adverse events related to intraoperative carbon dioxide insufflation occur. These are treated through percutaneous needle decompression and insertion of a chest drainage tube for pneumoperitoneum and pneumothorax, respectively. Caution should be exercised regarding the development of subcutaneous emphysema and its involvement in airway obstruction.
Prevention of aspiration pneumonia and adverse events related to the insufflation of carbon dioxide is essential in the management of esophageal achalasia through POEM. Close cooperation between gastrointestinal endoscopic surgeons and anesthesiologists is indispensable in POEM.
经口内镜下肌切开术（POEM）作为一种微创治疗方法，在日本被开发用于治疗需要全身麻醉下正压通气的食管失弛缓症。2018 年，日本胃肠内镜学会发布了第一份指南，描述了 POEM 的标准护理。基于这些指南，我们讨论了日本治疗食管失弛缓症时 POEM 麻醉的典型方法。
在麻醉诱导前必须对食管进行彻底清洗，以防止麻醉诱导期间发生吸入以及内镜切除食管黏膜后食管残留物污染纵隔和胸腔/腹腔。尽管罕见，但术中二氧化碳充气相关的不良事件仍会发生。这些可以通过经皮针减压和插入胸腔引流管来分别治疗气腹和气胸。应注意皮下气肿的发展及其对气道阻塞的影响。
通过 POEM 治疗食管失弛缓症时，预防吸入性肺炎和与二氧化碳充气相关的不良事件至关重要。胃肠内镜外科医生和麻醉师之间的密切合作对于 POEM 是必不可少的。
