Anesthesia for esophageal surgery
- Jennifer Macpherson, MD
Jennifer Macpherson, MD
- Assistant Professor of Anesthesiology
- University of Rochester, Rochester, New York
This topic will discuss anesthetic management of elective and urgent esophageal surgery, both open and endoscopic. Challenges include increased risks for pulmonary aspiration, possible need for one lung ventilation, and postoperative pain management.
Anesthetic techniques for esophagoscopy are reviewed separately. (See "Anesthesia for gastrointestinal endoscopy in adults".)
Preanesthetic planning for esophageal surgery includes:
●Minimizing risk of pulmonary aspiration. Many patients with esophageal disease have a high risk of pulmonary aspiration due to esophageal mass, stricture, or achalasia. Precautions for a full stomach are always employed since esophageal contents are unknown and retained ingested food may be present even after an appropriate fasting period. If general anesthesia is planned, these precautions include a rapid sequence induction and intubation (RSII) technique or awake endotracheal intubation. (See "Anesthesia for gastrointestinal endoscopy in adults", section on 'Airway management'.).
●Assessing the airway. If necessary, prepare to manage a difficult airway. (See "Management of the difficult airway for general anesthesia".)
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- PREANESTHETIC PLANNING
- ANESTHETIC TECHNIQUES
- General anesthesia
- - Premedication
- - Planned neuraxial analgesia
- - Induction
- Rapid sequence induction and intubation
- Considerations for one lung ventilation
- - Maintenance
- Inhalation and intravenous agents
- Neuraxial agents
- - Emergence
- Postoperative pain management
- - Open thoracotomy or laparotomy
- Epidural or paravertebral block
- Alternative analgesic strategies
- - Thoracoscopy or laparoscopy
- ANESTHETIC MANAGEMENT FOR SPECIFIC PROCEDURES
- - Monitoring
- - Anesthetic and pain management
- - Airway and ventilation management
- - Fluid and hemodynamic management
- - Extubation
- - Enhanced recovery protocols
- Emergency repair of esophageal perforation or rupture
- Repair of tracheoesophageal fistulae
- Repair of gastroesophageal reflux disease
- Repair of achalasia
- Repair of esophageal diverticuli
- PERIOPERATIVE COMPLICATIONS
- Intraoperative complications
- Early postoperative complications
- SUMMARY AND RECOMMENDATIONS