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Anesthesia for Esophageal Surgery

  • Randal S. BlankEmail author
  • Stephen R. Collins
  • Julie L. Huffmyer
  • J. Michael Jaeger
Chapter

Abstract

Surgical procedures involving the esophagus are performed for a wide array of elective and emergent indications. Esophageal surgeries may be performed for malignant or nonmalignant lesions or abnormalities and may involve various combinations of open or minimally invasive procedures via the neck, abdomen, and thorax and most recently via endoscopic approaches. Patients with severe esophageal disease may be at elevated risk of aspiration and anesthetic management should reflect an appreciation of this risk. For larger incisional approaches, particularly transthoracic procedures, pain control is of paramount importance; thoracic epidural analgesia remains the gold standard for such patients and procedures although alternative approaches such as paravertebral blockade may provide equivalent analgesia for some procedures. Patients undergoing major transthoracic esophageal surgeries, particularly esophagectomy, are at elevated risk for major morbidity, especially pulmonary complications and anastomotic failure and leak. Preoperative optimization of such patients should be a priority for the perioperative physician and may include programs designed to treat underlying comorbidities, optimize nutrition, improve inspiratory muscle function, and prevent and treat anemia. Additional perioperative efforts should be made to optimize pain control, avoid iatrogenic fluid overload, employ lung-protective ventilation, and facilitate early extubation and mobilization. Early removal of gastric tubes and oral enteral feeding remain controversial and require more study.

Keywords

Esophagus Esophageal surgery Esophagectomy Transhiatal esophagectomy Transthoracic esophagectomy Three-hole esophagectomy Ivor Lewis esophagectomy McKeown esophagectomy Minimally invasive esophagectomy Robotic esophagectomy Anastomosis Anastomotic leak Anastomotic failure Gastroesophageal reflux Hiatal hernia Paraesophageal hernia Fundoplication Esophageal perforation Esophageal rupture Achalasia Esophagomyotomy Tracheoesophageal fistula Esophageal diverticula Esophageal cancer Gastric conduit Pain control Epidural analgesia Aspiration Cricoid pressure Fluid management Esophagoscopy Nissen fundoplication Belsey fundoplication Collis gastroplasty Pulmonary complications 

Abbreviations

ALI

Acute lung injury

ARDS

Acute respiratory distress syndrome

COPD

Chronic obstructive pulmonary disease

CT

Computerized tomography

CXR

Chest X-ray (radiograph)

DLT

Double-lumen endotracheal tube(s)

ECG

Electrocardiogram

EGD

Esophagogastroduodenoscopy

ERAS

Enhanced recovery after surgery

EUS

Endoscopic ultrasound

GDFT

Goal-directed fluid therapy

GERD

Gastroesophageal reflux disease

GI

Gastrointestinal

LEA

Lumbar epidural analgesia

LES

Lower esophageal sphincter

LVEDVI

Left ventricular end-diastolic volume index

MIE

Minimally invasive esophagectomy

MRI

Magnetic resonance imaging

NGT

Nasogastric tube

OLV

One-lung ventilation

PCA

Patient-controlled analgesia

PEEP

Positive end-expiratory pressure

PET

Positron emission tomography

PH

Paraesophageal hernia(s)

PONV

Postoperative nausea and vomiting

PVB

Paravertebral block

SLT

Single-lumen endotracheal tube(s)

SVV

Stroke volume variation

TEA

Thoracic epidural analgesia

TEF

Tracheoesophageal fistula

THE

Transhiatal esophagectomy

TTE

Transthoracic esophagectomy

UES

Upper esophageal sphincter

Supplementary material

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Randal S. Blank
    • 1
  • Stephen R. Collins
    • 1
  • Julie L. Huffmyer
    • 1
  • J. Michael Jaeger
    • 1
  1. 1.Department of AnesthesiologyUniversity of Virginia Health SystemCharlottesvilleUSA

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