ANAESTHETIC MANAGEMENT OF A CASE OF ZENKER'S DIVERTICULUM POSTED FOR Z-POEM UNDER GENERAL ANAESTHESIA

Abstract

Zenker's diverticulum is a rare disorder characterized by the herniation of the post-pharyngeal wall through the Killian's triangle, located between the inferior constrictor muscle and the cricopharyngeus muscle. Surgical intervention used to be the primary treatment for Zenker's diverticulum, despite its high morbidity and mortality rates. In recent years, Z-POEM, a technique utilizing third-space endoscopy, has emerged, specically tailored for Zenker's diverticulum. It is a relatively new addition to the natural orice transluminal endoscopic surgeries (NOTES). Usually carried out in endoscopy suites, a crucial step in the procedure involves creating a submucosal tunnel in the esophageal wall and the continuous insufation of CO2 can inadvertently lead to complications such as subcutaneous emphysema, capnomediastinum, capnothorax, or even capnoperitoneum, due to tracking of CO2 in surrounding tissues. Anesthesiologists face the challenge of not only administering anesthesia in a remote location, but also promptly detecting and managing these complications. Here, we outline the effective anesthetic management in the case of an adult male diagnosed with Zenker's Diverticulum who underwent Z-POEM procedure under General Anesthesia.