piperidines and Esophageal-Achalasia

Topics: Aflatoxins; Africa; Age Factors; Aged; Alcohol Drinking; Anemia, Hypochromic; Anemia, Pernicious; Blood Group Antigens; Carcinogens; Celiac Disease; Esophageal Achalasia; Esophageal Neoplasms; Europe; Female; Gastrectomy; Humans; Japan; Keratosis; Male; Molybdenum; Nitrosamines; Nitroso Compounds; Piperidines; Plants; Precancerous Conditions; Sex Factors; Smoking; Stomach Neoplasms

Peroral endoscopic myotomy (POEM) is a newly developed, less invasive treatment for esophageal achalasia that requires general anesthesia under positive pressure ventilation. In this retrospective case series, we describe the anesthetic management of 28 consecutive patients who underwent POEM for esophageal achalasia. Anesthesia was maintained with sevoflurane and remifentanil under positive pressure ventilation through a tracheal tube. Retained contents in the esophagus were evacuated just before anesthesia induction to prevent regurgitation into the trachea. The POEM procedure was performed using an orally inserted flexible fiberscope. Elevation of end-tidal carbon dioxide after initiating esophageal carbon dioxide insufflation was observed in all patients and was treated by minute adjustments to the ventilation volume. Scopolamine butylbromide-induced tachycardia in one patient was treated with landiolol hydrochloride, which is a short-acting beta 1-selective blocker. Minor subcutaneous emphysema around the neck was observed in one patient. POEM was successfully completed, and tracheas were extubated immediately after the procedure in all patients. Our findings suggest that prevention of aspiration pneumonia during anesthesia induction, preparation for carbon dioxide insufflation-related complications, and treatment of scopolamine butylbromide-induced tachycardia play important roles in safe anesthesia management of POEM for esophageal achalasia.

Topics: Adult; Aged; Aged, 80 and over; Analgesics, Opioid; Anesthesia, General; Anesthetics, Inhalation; Carbon Dioxide; Endoscopy; Esophageal Achalasia; Esophagus; Female; Humans; Insufflation; Male; Methyl Ethers; Middle Aged; Muscles; Piperidines; Remifentanil; Retrospective Studies; Sevoflurane; Young Adult

We report a case of oesophageal disease as the first manifestation in a patient with CREST syndrome. A 46-year-old man with achalasia-like syndrome developed CREST syndrome 4 years later. A pneumatic dilatation of the cardia was performed. After pneumatic dilatation the dysphagia and regurgitation disappeared but the patient developed reflux oesophagitis. Four years after diagnosis of oesophageal disease he presented with a clinical picture of CREST syndrome. An acute ileus and constipation developed later. After receiving medical therapy with omeprazole and cisapride the patient is free of oesophageal symptoms and bowel movements are normal. Oesophageal disease is common in patients with limited and diffuse scleroderma, but to our knowledge achalasia-like syndrome has not been previously described as the first manifestation of the systemic disease.

Topics: Anti-Ulcer Agents; Cardia; Cisapride; Constipation; CREST Syndrome; Dilatation; Esophageal Achalasia; Esophagitis, Peptic; Humans; Intestinal Obstruction; Male; Middle Aged; Omeprazole; Piperidines

Topics: Esophageal Achalasia; Humans; Piperidines