Pediatric anesthesia and achalasia: 10 years’ experience in peroral endoscopy myotomy management
Abstract Background Endoscopic treatment for achalasia (POEM) is a recently introduced technique that incorporates the concepts of natural orifice transluminal surgery. Although pediatric achalasia is rare, POEM has been episodically used in children since 2012. Despite this procedure entails many i...
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| Format: | Article |
| Language: | English |
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BMC
2022-06-01
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| Series: | Journal of Anesthesia, Analgesia and Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s44158-022-00054-7 |
| _version_ | 1798028696381030400 |
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| author | Fabio Sbaraglia Pietro Familiari Federica Maiellare Marco Mecarello Annamaria Scarano Demetrio Del Prete Rosa Lamacchia Federica Antonicelli Marco Rossi |
| author_facet | Fabio Sbaraglia Pietro Familiari Federica Maiellare Marco Mecarello Annamaria Scarano Demetrio Del Prete Rosa Lamacchia Federica Antonicelli Marco Rossi |
| author_sort | Fabio Sbaraglia |
| collection | DOAJ |
| description | Abstract Background Endoscopic treatment for achalasia (POEM) is a recently introduced technique that incorporates the concepts of natural orifice transluminal surgery. Although pediatric achalasia is rare, POEM has been episodically used in children since 2012. Despite this procedure entails many implications for airway management and mechanical ventilation, evidences about anesthesiologic management are very poor. We conducted this retrospective study to pay attention on the clinical challenge for pediatric anesthesiologists. We put special emphasis on the risk in intubation maneuvers and in ventilation settings. Results We retrieved data on children 18 years old and younger who underwent POEM in a single tertiary referral endoscopic center between 2012 and 2021. Demographics, clinical history, fasting status, anesthesia induction, airway management, anesthesia maintenance, timing of anesthesia and procedure, PONV, and pain treatment and adverse events were retrieved from the original database. Thirty-one patients (3–18 years) undergoing POEM for achalasia were analyzed. In 30 of the 31 patients, rapid sequence induction was performed. All patients manifested consequences of endoscopic CO2 insufflation and most of them required a new ventilator approach. No life-threatening adverse events have been detected. Conclusions POEM procedure seems to be characterized by a low-risk profile, but specials precaution must be taken. The inhalation risk is actually due to the high rate of full esophagus patients, even if the Rapid Sequence Induction was effective in preventing ab ingestis pneumonia. Mechanical ventilation may be difficult during the tunnelization step. Future prospective trials will be necessary to individuate the better choices in such a special setting. |
| first_indexed | 2024-04-11T19:12:09Z |
| format | Article |
| id | doaj.art-bc524f9ea76343d7b35ec6b4b7af5eee |
| institution | Directory Open Access Journal |
| issn | 2731-3786 |
| language | English |
| last_indexed | 2024-04-11T19:12:09Z |
| publishDate | 2022-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Anesthesia, Analgesia and Critical Care |
| spelling | doaj.art-bc524f9ea76343d7b35ec6b4b7af5eee2022-12-22T04:07:35ZengBMCJournal of Anesthesia, Analgesia and Critical Care2731-37862022-06-01211710.1186/s44158-022-00054-7Pediatric anesthesia and achalasia: 10 years’ experience in peroral endoscopy myotomy managementFabio Sbaraglia0Pietro Familiari1Federica Maiellare2Marco Mecarello3Annamaria Scarano4Demetrio Del Prete5Rosa Lamacchia6Federica Antonicelli7Marco Rossi8Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario “A Gemelli” IRCCSDigestive Endoscopy Unit, Fondazione Policlinico Universitario “A Gemelli” IRCCSDepartment of Anesthesia and Intensive Care, Fondazione Policlinico Universitario “A Gemelli” IRCCSDepartment of Anesthesia and Intensive Care, Fondazione Policlinico Universitario “A Gemelli” IRCCSDepartment of Anesthesia and Intensive Care, Fondazione Policlinico Universitario “A Gemelli” IRCCSDepartment of Anesthesia and Intensive Care, Fondazione Policlinico Universitario “A Gemelli” IRCCSDepartment of Anesthesia and Intensive Care, Fondazione Policlinico Universitario “A Gemelli” IRCCSDepartment of Anesthesia and Intensive Care, Fondazione Policlinico Universitario “A Gemelli” IRCCSDepartment of Anesthesia and Intensive Care, Fondazione Policlinico Universitario “A Gemelli” IRCCSAbstract Background Endoscopic treatment for achalasia (POEM) is a recently introduced technique that incorporates the concepts of natural orifice transluminal surgery. Although pediatric achalasia is rare, POEM has been episodically used in children since 2012. Despite this procedure entails many implications for airway management and mechanical ventilation, evidences about anesthesiologic management are very poor. We conducted this retrospective study to pay attention on the clinical challenge for pediatric anesthesiologists. We put special emphasis on the risk in intubation maneuvers and in ventilation settings. Results We retrieved data on children 18 years old and younger who underwent POEM in a single tertiary referral endoscopic center between 2012 and 2021. Demographics, clinical history, fasting status, anesthesia induction, airway management, anesthesia maintenance, timing of anesthesia and procedure, PONV, and pain treatment and adverse events were retrieved from the original database. Thirty-one patients (3–18 years) undergoing POEM for achalasia were analyzed. In 30 of the 31 patients, rapid sequence induction was performed. All patients manifested consequences of endoscopic CO2 insufflation and most of them required a new ventilator approach. No life-threatening adverse events have been detected. Conclusions POEM procedure seems to be characterized by a low-risk profile, but specials precaution must be taken. The inhalation risk is actually due to the high rate of full esophagus patients, even if the Rapid Sequence Induction was effective in preventing ab ingestis pneumonia. Mechanical ventilation may be difficult during the tunnelization step. Future prospective trials will be necessary to individuate the better choices in such a special setting.https://doi.org/10.1186/s44158-022-00054-7Pediatric anesthesiaEndoscopyAdverse eventsRapid sequence inductionMechanical ventilation |
| spellingShingle | Fabio Sbaraglia Pietro Familiari Federica Maiellare Marco Mecarello Annamaria Scarano Demetrio Del Prete Rosa Lamacchia Federica Antonicelli Marco Rossi Pediatric anesthesia and achalasia: 10 years’ experience in peroral endoscopy myotomy management Journal of Anesthesia, Analgesia and Critical Care Pediatric anesthesia Endoscopy Adverse events Rapid sequence induction Mechanical ventilation |
| title | Pediatric anesthesia and achalasia: 10 years’ experience in peroral endoscopy myotomy management |
| title_full | Pediatric anesthesia and achalasia: 10 years’ experience in peroral endoscopy myotomy management |
| title_fullStr | Pediatric anesthesia and achalasia: 10 years’ experience in peroral endoscopy myotomy management |
| title_full_unstemmed | Pediatric anesthesia and achalasia: 10 years’ experience in peroral endoscopy myotomy management |
| title_short | Pediatric anesthesia and achalasia: 10 years’ experience in peroral endoscopy myotomy management |
| title_sort | pediatric anesthesia and achalasia 10 years experience in peroral endoscopy myotomy management |
| topic | Pediatric anesthesia Endoscopy Adverse events Rapid sequence induction Mechanical ventilation |
| url | https://doi.org/10.1186/s44158-022-00054-7 |
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