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The Ventilatory Changes of Pediatric Peroral Endoscopic Myotomy Patients
Mete Manici1, Agah Rauf İşgüzar2, Umut Deniz Adanur1
1Koç University Hospital, Clinic of Anaesthesiology and Reanimation, İstanbul, Turkey.
Insights
Peroral endoscopic myotomy (POEM) is safe for pediatric achalasia patients. Specialized anesthetic management is crucial for perioperative care, addressing potential complications like increased end-tidal carbon dioxide (ETCO2) during this procedure.
Area of Science:
- Pediatric Anesthesiology
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Peroral endoscopic myotomy (POEM) is an effective treatment for achalasia in children.
- Limited evidence exists regarding the specific anesthetic management for pediatric patients undergoing POEM.
- This study addresses the need for understanding perioperative anesthetic strategies in this population.
Purpose of the Study:
- To present perioperative and postoperative anesthetic management strategies for pediatric patients with achalasia undergoing POEM.
- To highlight key considerations for anesthesia in pediatric POEM procedures.
- To contribute to the development of standardized anesthetic protocols for pediatric POEM.
Main Methods:
- Retrospective review of 16 pediatric patients who underwent POEM for achalasia (2017-2020).
- Evaluation of demographic data, anesthetic techniques, mechanical ventilation, and recovery parameters.
- Analysis of perioperative monitoring, pain management, and adverse events.
Main Results:
- The study included 7 female and 9 male patients with a mean age of 5.5 years.
- Anesthetic maintenance involved sevoflurane, remifentanil, and rocuronium.
- Needle decompression for capnoperitoneum was required in 87.5% of patients; no adverse events were reported.
- Mean procedure and recovery room durations were 66 and 62 minutes, respectively.
Conclusions:
- POEM demonstrates safety and effectiveness in pediatric achalasia patients.
- Specialized anesthetic management is essential due to the unique challenges of pediatric patients.
- Understanding and managing perioperative complications, such as elevated ETCO2, is critical for successful POEM outcomes.
Objective:
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.
Methods:
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.
Results:
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.
Conclusion:
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.
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