Related Experiment Videos
Esophageal balloon dilation in children: prospective analysis of hemodynamic changes and complications during general
Arzu Gerçek1, Binnaz Ay, Varlik Dogan
1Department of Anesthesiology and Reanimation, Institute of Neurological Science, Marmara University, 34854 Istanbul, Turkey. arzugercek@yahoo.com
Insights
Pediatric balloon dilation for esophageal strictures can cause significant hemodynamic changes, including increased heart rate and blood pressure. Anesthesiologists must monitor for airway complications like obstruction and bleeding.
Area of Science:
- Pediatric Anesthesiology
- Gastroenterology
- Interventional Endoscopy
Background:
- Benign esophageal strictures in children often result from caustic ingestion.
- Balloon dilation is a common treatment modality for pediatric esophageal strictures.
Purpose of the Study:
- To evaluate hemodynamic alterations during pediatric esophageal balloon dilation.
- To identify potential complications associated with this procedure in children.
Main Methods:
- Prospective, controlled study involving pediatric patients (ASA physical status I-II) with benign esophageal strictures.
- Anesthesia utilized propofol, cisatracurium, nitrous oxide, and sevoflurane.
- Progressive balloon sizing to achieve stricture dilation.
Main Results:
- 18 sessions and 99 dilations were performed in 5 children.
- Significant increases in heart rate and blood pressure were observed during balloon inflation in 95% of dilations.
- Complications included bleeding (4 cases), endotracheal tube obstruction (2 cases), and postextubation bronchospasm (2 cases).
Conclusions:
- Esophageal balloon dilation in children can induce significant hemodynamic instability.
- Anesthesiologists must anticipate and manage potential airway complications, including endotracheal tube obstruction and bleeding.
- Careful airway management is crucial during this pediatric endoscopic procedure.
Study Objective:
To investigate hemodynamic changes and complications in children during balloon dilation of esophageal strictures.
Design:
Prospective, controlled study.
Setting:
University teaching hospital.
Patients:
5 ASA physical status I and II pediatric patients with benign esophageal stricture related to ingestion of caustic substances.
Interventions:
Anesthesia was induced with intravenous propofol two mg/kg and cisatracurium 0.2 mg/kg and maintained with 66% nitrous oxide and one minimum alveolar concentration of sevoflurane in oxygen. In each session, balloon size was increased until the stricture was opened.
Measurements And Results:
A total of 18 sessions and 99 dilations in 5 children performed over a one-year period were included in the study. In 8 of 18 sessions, esophageal stricture was located in the middle one third of the esophagus; and in the others, in the upper one third. Four cases experienced bleeding; two cases, inability to ventilate due to obstruction of the endotracheal tube tip by the inflated balloon; and two cases, postextubation bronchospasm. In 95 of the 99 dilations, while the balloon was inflated, heart rate was faster and blood pressure increased significantly.
Conclusion:
Anesthesiologists should keep in mind the possibility of hemodynamic instability and possible endotracheal tube tip obstruction by the inflated balloon and safeguard the airway against bleeding, secretions, and radio-opaque fluid during esophageal balloon dilation.
Related Concept Videos
01:29Endoscopic Procedures I: Esophagogastroduodenoscopy
During an EGD, the endoscope can be used to:
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
01:30Esophageal Strictures-I: Introduction
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...