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Letter to the Editor
Achalasia case detected during endoscopy application accompanied by anaesthesia
Recai Dağlı, Hakan Bayır, Bilal Ergül, Nazan Kocaoğlu, Zeynel Abidin Erbesler
Gastroenterology Rev 2016; 11 (4): 302–303
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Achalasia is an uncommon dysfunctional neuromuscular disease of the oesophagus. General anaesthesia might be required for its diagnosis and treatment. During the anaesthesia, complications such as oesophagus dilatation-perforation and tracheal aspiration in oesophagus content might be seen. In order to ensure the security of the respiratory tract, rapid intubation might be required . When anaesthesia is required in endoscopy units for diagnosis, equipment and devices standardised for outpatient anaesthesia applications by American Society of Anaesthesiologists (ASA) should immediately be ready .
A 41-year-old male patient, who applied to the Gastroenterology Polyclinic due to gastric complaints and had lymphadenopathy detected in his abdomen ultrasonography, was scheduled for conscious endoscopy. He was unable to tolerate the endoscopy which was applied following twelve-hour fasting, and he vomited. Endoscopy with anaesthesia was then planned, rescheduled with two weeks of strict liquid food diet and pineapple juice application. The patient was taken to the endoscopy unit following 24 h of fasting, and was monitored with ECG and pulse oximeter. Intubation was then planned. Anaesthesia induction was conducted with 50 mg of remifentanil and 100 mg of propofol. While O2 was provided with a mask, the intraoral and oropharyngeal area was filled with liquid. Despite rapid aspiration, the contents continuously flowed to intraoral area, and the patient’s saturation dropped. He was immediately intubated. In the meantime, the amount of aspired liquid content was 900 ml. Having reached normal levels of saturation and haemodynamic values in the patient, endoscopy operation began with propofol addition. Significant achalasia and duedenal ulcers were detected. When the patient’s respiration was sufficient, he was extubated. The patient, who did not have respiratory problems and whose haemodynamics were stable, was sent to the service without a problem upon observation at the patient recovery room.
In outpatient anaesthesia applications, various mortality rates and complications have been reported. During operation, complications may occur such as; allergic reactions, nausea-vomiting, aspiration of the gastric content, and damaging of the team according to the environment with hypovolaemia. It has been reported that respiratory problems have been encountered in old patients the most, and complications have been encountered mostly in the...
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