Autonomic Dysfunction and Hemodynamic Instability During Per-oral Endoscopic Myotomy

Gangnam Severance Hospital40 enrolled

Overview

This prospective observational study aims to investigate the association between the autonomic dysfunction and hemodynamic instability during per-oral endoscopic myotomy under general anesthesia in achalasia patients. Per-oral endoscopic myotomy is known as the effective treatment for achalasia patients. During per-oral endoscopic myotomy, capnoperitoneum, capnomediastinum, and systemic CO2 accumulation can potentially impair hemodynamics. Moreover, it has been suggested that achalasia is associated with autonomic dysfunction. We hypothesized that patients with autonomic dysfunstion would esperience more hemodynamic instability during per-oral endoscopic myotomy compared with patients without autonomic dysfunction. In this prospective observational study, the autonomic function test will be performed before surgery, and advanced hemodynamic parameters will be recorded using EV1000 clinical platform (Edwards Lifesciences, USA) during surgery. The association between the autonomic dysfunction and hemodynamic instability during per-oral endoscopic myotomy will be analyzed.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Achalasia

Interventions

Per-oral endoscopic myotomyPROCEDURE

Per-oral endoscopic myotomy will be performed under general anesthesia. Per-oral endoscopic myotomy will be performed according to the standard care. General anesthesia will be conducted according to the standard care in our institution, and standardized as follows. * Monitoring: ECG, SpO2, noninvasive blood pressure, invasive blood pressure monitoring via radial artery cannulation, advanced hemodynamic monitoring (including cardiac output, cardiac index) uisng EV1000 clinical platform (Edwards Lifesciences, USA), anesthetic depth monitoring by SedLine Sedation monitor (Masimo corporation). * Anesthetic induction: Target controlled infusion (TCI) of Remifentanil (target 3.0 ng/mL), propofol 2 mg/kg IV, rocuronium 0.8 mg/kg IV * Anesthetic maintence: sevoflurane 0.9 age corrected MAC and remifentanil TCI (target range 1.0-4.0 ng/mL)

Eligibility

Sex: ALLMin age: 19 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Patients who are scheduled to undergo per-oral endoscopic myotomy in Gangnam Severance Hospital 2. Patients aged ≥ 19 years Exclusion Criteria: 1. Patients who are hemodynamically unstable before surgery 2. Patients in whom preoperative heart rate variability (HRV) test cannot be conducted 3. Pregnant women of breastfeeding women 4. Patients unable to read the informed consent form

Outcomes

Primary Outcomes

Wobble of Systolic Arterial Pressure (SAP) during surgery

Wobble of SAP will be calculated according to the following formula. Performance Error (PE (%)) = (measured SAP-reference SAP) × 100/reference SAP Median performance error (MDPE (%)) = median {PEi, i = 1, 2, 3…, N} Median absolute performance error (MDAPE (%)) = median {\|PE\| , i = 1, 2, 3…, N} (N, number of measured SAP) Wobble (%) = median{\|MDPE - PEi\|, i = 1, 2, 3…, N}(N, number of measured PE) reference SAP = 120 mmHg

Time frame: During the intraoperative period, from the enterance to the operating room to the emergence of anesthesia