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Chapter 4
Studies
Three retrospective cohort studies with specific focus on anaesthesia technique during
POEM have recently been published.
5,7,8
In 2014 Tanaka et al.
7
reported on 28 patients who underwent POEM after 24 hours fasting.
Before POEM, these patients underwent oesophago-gastroscopy under sedation with
the aim to remove remaining food in the oesophagus and stomach. Afterwards, their
trachea was intubated after administration of propofol, remifentanil, and rocuronium (a
specific method of intubation was not described), and anaesthesia was maintained with
sevoflurane and remifentanil. During the following endoscopy, it was noticed that still in
ten patients solid food and in four patients liquid was in the oesophagus. One patient
developed subcutaneous emphysema. No other complications were observed. All patients
could easily be extubated.
7
In 2015, Yang et al.
8
described 52 patients who underwent POEM in the US. All patients had
nothing per os for eight hours and had fed for a varying period from 48 hours up to 5 days
only upon clear liquids. All patients received preoperative antibiotics and proton pump
inhibitors until discharge home. Intubation was performed as “rapid sequence induction”
(RSI) (medication is not reported) and anaesthesia was obtained with propofol and/or
sevoflurane. No regurgitation or aspiration was observed during induction. Postoperatively,
all patients had a chest x-ray and on the day after procedure barium swallow or a CT
scan with oral contrast to eliminate leakage. Patients received a soft pureed diet for two
weeks. Some patients developed high ventilation pressures during procedure that could
be easily remedied by endoscopic decompression of the stomach. Six patients had a
pneumoperitoneum, for which decompression of the abdomen with a Veres needle was
necessary. Except for one patient with severe COPD, all patients could be extubated in
the endoscopy room. Four patients experienced perforation of the oesophagus. In three
patients this was noticed and treated immediately during procedure. Perforation in the
fourth patient was discovered on the day after procedure during barium swallow. This
patient had to undergo laparoscopic repair combined with temporary placement of an
endoluminal stent. All patients fully recovered. There were no bleeding complications. Two
patients developed pneumonia after the procedure. The average length of stay in hospital
was 3.5 days (range 2-10 days).
Several months ago, a third case series of 24 patients was published.
5
Again, there was
neither uniform fasting policy nor airway management. Fasting time varied from 6 up
to 25 hours. Sixteen patients received standard induction without special measures to
prevent aspiration, 7 patients received RSI with cricoid pressure and one without. One