Sanli Mukadder, Akbulut Sami, Ucar Muharrem, Bilgic Yilmaz
Department of Anesthesiology and Reanimation, Inonu University Faculty of Medicine, 44280 Malatya, Turkey.
Department of Surgery, Inonu University Faculty of Medicine, 44280 Malatya, Turkey.
J Clin Med. 2025 Sep 16;14(18):6504. doi: 10.3390/jcm14186504.
: Achalasia is a primary esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and absent peristalsis, which increases the risk of aspiration during anesthesia. Peroral endoscopic myotomy (POEM) is a minimally invasive therapeutic approach requiring tailored anesthetic management. This study aimed to evaluate perioperative anesthesia management during POEM, focusing on ventilation parameters, intraoperative hemodynamics, laboratory changes, and the incidence and severity of postoperative complications. : A retrospective analysis was conducted on 51 patients who underwent POEM between June 2016 and April 2025. Demographic features, anesthesia techniques, intraoperative physiologic parameters, hematologic profiles, and postoperative complications were evaluated. Standard preoperative fasting protocols were implemented. Rapid sequence induction (RSI) with propofol and rocuronium was followed by endotracheal intubation. Desflurane was used for maintenance anesthesia, with ventilation settings adjusted to limit end-tidal carbon dioxide (ETCO) elevation. The median age of patients was 48 years, with a slight female (52.9%) predominance. Most patients were American Society of Anesthesiologists (ASA) II (64.7%) or ASA III (35.3%) scores and had comorbid hypertension (31.4%) or diabetes (11.8%). The median anesthesia duration was 180 min, and the peak inspiratory pressure remained stable at 25 mmHg. Oxygen saturation (SpO) improved during the procedure, while ETCO increased from baseline to 49 mmHg by the end. Blood pressure declined transiently but recovered intraoperatively. Hematologic analysis showed significant increases in white blood cell (WBC) and neutrophils and mild decreases in hemoglobin, hematocrit, and platelets. Early postoperative complications included subcutaneous emphysema (19.6%), minor bleeding (9.8%), and pneumoperitoneum (7.84%). Two patients required tube thoracostomy due to pneumothorax, but no patient developed a complication requiring surgical exploration. During a median follow-up of 546 days, no mortality was reported. Long-term complications were infrequent, with gastroesophageal reflux disease (GERD) (3.92%) and esophagitis (1.96%) being the most notable. POEM can be performed safely with appropriate anesthetic management. Despite significant physiologic changes during carbon dioxide (CO) insufflation, no life-threatening complications occurred, and the majority of adverse events were minor and self-limiting. Close intraoperative monitoring and interdisciplinary coordination contribute to favorable perioperative outcomes.
贲门失弛缓症是一种原发性食管动力障碍性疾病，其特征为食管下括约肌（LES）松弛受损和蠕动消失，这增加了麻醉期间误吸的风险。经口内镜肌切开术（POEM）是一种需要定制麻醉管理的微创治疗方法。本研究旨在评估POEM围手术期的麻醉管理，重点关注通气参数、术中血流动力学、实验室检查变化以及术后并发症的发生率和严重程度。
对2016年6月至2025年4月期间接受POEM治疗的51例患者进行回顾性分析。评估了人口统计学特征、麻醉技术、术中生理参数、血液学指标和术后并发症。实施了标准的术前禁食方案。采用丙泊酚和罗库溴铵进行快速顺序诱导（RSI），随后进行气管插管。使用地氟醚维持麻醉，调整通气设置以限制呼气末二氧化碳（ETCO）升高。患者的中位年龄为48岁，女性略占优势（52.9%）。大多数患者美国麻醉医师协会（ASA）评分为II级（64.7%）或III级（35.3%），并患有合并症高血压（31.4%）或糖尿病（11.8%）。中位麻醉持续时间为180分钟，吸气峰压保持稳定在25 mmHg。术中氧饱和度（SpO）改善，而ETCO在手术结束时从基线升至49 mmHg。血压短暂下降但术中恢复。血液学分析显示白细胞（WBC）和中性粒细胞显著增加，血红蛋白、血细胞比容和血小板轻度下降。术后早期并发症包括皮下气肿（19.6%）、少量出血（9.8%）和气腹（7.84%）。两名患者因气胸需要进行胸腔闭式引流，但没有患者出现需要手术探查的并发症。在中位随访546天期间，未报告死亡病例。长期并发症很少见，最显著的是胃食管反流病（GERD）（3.92%）和食管炎（1.96%）。
在适当的麻醉管理下，POEM可以安全进行。尽管在二氧化碳（CO）充气期间发生了显著的生理变化，但未发生危及生命的并发症，且大多数不良事件轻微且为自限性。术中密切监测和多学科协作有助于获得良好的围手术期结果。
