Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.11.020
Brazilian Journal of Anesthesiology
Clinical Informations

Tension pneumothorax during peroral endoscopic myotomy for treatment of esophageal achalasia under general anesthesia

Pneumotórax de tensão durante miotomia endoscópica por via oral para tratamento de megaesôfago sob anestesia geral

Tsung-Shih Li; Tsung-Yang Lee; Kate Hsiurong Liao

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Abstract

Abstract More and more endoscopically gastrointestinal procedures require anesthesiologists to perform general anesthesia, such as "peroral endoscopic myotomy". Peroral endoscopic myotomy is a novel invasive treatment for the primary motility disorder of esophagus, called esophageal achalasia. Despite of its minimally invasive feature, there are still complications during the procedure which develop to critical conditions and threat patients’ lives. Herein we describe a case about tension pneumothorax subsequent to esophageal rupture during peroral endoscopic myotomy. The emergent management of the complication is stated in detail. The pivotal points of general anesthesia for patients undergoing peroral endoscopic myotomy are emphasized and discussed. Also, intraoperative and post-operative complications mentioned by literature are integrated.

Keywords

Peroral endoscopic myotomy, Tension pneumothorax, Esophageal achalasia, General anesthesia

Resumo

Resumo Cada vez mais os procedimentos gastrointestinais feitos por endoscopia, tais como a miotomia endoscópica por via oral (MEVO), exigem anestesiologistas para administrar anestesia geral. A MEVO é um novo tratamento invasivo para o distúrbio de motilidade primária do esôfago, denominado acalasia esofágica (AE). Apesar de sua característica minimamente invasiva, existem complicações durante o procedimento que evoluem para condições críticas e de risco à vida. Descrevemos aqui um caso de pneumotórax hipertensivo após a ruptura do esôfago durante uma MEVO. O tratamento de emergência da complicação é relatado em detalhes. Os pontos cruciais da anestesia geral para pacientes submetidos à MEVO são enfatizados e discutidos. Além disso, as complicações mencionadas pela literatura nos períodos intraoperatório e pós-operatório são integradas ao texto.

Palavras-chave

Miotomia endoscópica por via oral, Pneumotórax hipertensivo, Acalasia esofágica, Anestesia geral

References

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