Manici Mete, İşgüzar Agah Rauf, Adanur Umut Deniz, Gürkan Yavuz, Söğüt Muhammed Selman, Aslan Fatih, Arıkan Çiğdem
Koç University Hospital, Clinic of Anaesthesiology and Reanimation, İstanbul, Turkey.
University Hospital of Derby and Bourton, Department of Anaesthesiology and Reanimation, Derby, United Kingdom.
Turk J Anaesthesiol Reanim. 2024 Jul 12;52(3):101-106. doi: 10.4274/TJAR.2024.241609.
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.
经口内镜下肌切开术（POEM）已被证明是治疗成人和儿童贲门失弛缓症的一种成功治疗方法。然而，对于接受POEM手术的儿科患者的麻醉管理，目前缺乏证据。在本研究中，我们旨在从麻醉角度介绍儿科贲门失弛缓症患者的围手术期和术后管理策略。
回顾了2017年至2020年期间在单一中心接受POEM手术治疗贲门失弛缓症的16例儿科患者的病历。评估了患者的人口统计学数据、术前饮食、体重指数、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、恢复时间、住院时间、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5.5岁。麻醉维持采用在40%-60%氧气-空气混合气体中给予0.8-1.2最低肺泡浓度的七氟醚、瑞芬太尼输注和罗库溴铵推注剂量。压力控制通气模式下通气的患者中位年龄为3岁，容量控制通气模式下为10岁。调整呼吸频率和分钟通气量以维持呼气末二氧化碳（ETCO2）低于45 mmHg。14例患者（87.5%）采用针吸减压治疗气腹。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。总共8例患者（50%）术后使用对乙酰氨基酚和曲马多进行疼痛管理。术后期间无不良事件发生，所有患者平均3天出院。
POEM在儿科患者的安全性和有效性方面已显示出令人鼓舞的结果。由于儿科患者的特殊性，必须认识到该手术需要专业的麻醉管理。处理ETCO2升高的围手术期并发症需要了解纵隔气肿和气腹的生理结果。除了已知的麻醉管理策略外，应为每个患者采用量身定制的方法。应进行进一步研究以制定标准化管理方案。
