A case of ventilatory impairment during per-oral endoscopic myotomy under general anesthesia

We report a case of unexpected ventilatory impairment that occurred during per-oral endoscopic myotomy (POEM) under general anesthesia. A 73-year-old woman underwent POEM for Jackhammer esophagus. The patient developed hypercarbia, pneumoperitoneum, and severe subcutaneous emphysema during the operation. Although she was treated with abdominal paracentesis, it became difficult to ventilate her lungs a few minutes later. We recommended the surgeons to interrupt the procedure and proposed repeating the abdominal paracentesis. Simultaneously, we switched to manual ventilation and waited for the subcutaneous emphysema to subside. Thereafter, her respiratory status gradually improved and the surgeons were able to continue the operation. We considered that the main reason for our patient’s severe ventilatory impairment was that the length of surgical dissection was longer than usual.