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Anesthesia for Esophageal Surgery

  • Randal S. Blank
  • Julie L. Huffmyer
  • J. Michael Jaeger
Chapter

Abstract

Patients presenting for esophageal surgery frequently have comorbidities including cardiopulmonary disease which should be evaluated per published ACC/AHA guidelines. Particular attention should be paid to symptoms and signs of esophageal obstruction, gastroesophageal reflux disease (GERD), and malnutrition which may affect the risk of perioperative complications. Postoperative pain control strategies are dictated by the surgical approach to the esophagus. Use of thoracic epidural analgesia in patients undergoing transthoracic esophageal surgery provides optimal pain control, permits early patient extubation and mobilization, and may improve outcomes. Patients presenting for esophageal surgery commonly have pathology which increases their risk of regurgitation and aspiration. This is particularly true for patients with achalasia and other motor disorders of the esophagus, patients with high-grade esophageal obstruction, and those with severe GERD. Consideration should be given to pharmacologic prophylaxis, awake or rapid sequence induction in a head-up position, and appropriate postoperative care, including gastric drainage. Excessive perioperative intravenous fluid administration, especially crystalloid, may lead to exaggerated fluid shifts toward the interstitial space causing increased complications such as poor wound healing, slower return of GI function, abdominal compartment syndrome, impaired anastomotic healing, increased cardiac demand, pneumonia, and respiratory failure. The ideal fluid regimen for major esophageal surgery should be individualized, optimizing cardiac output and oxygen delivery while avoiding excessive fluid administration. Patients presenting for emergent repair of esophageal disruption, rupture or perforation may present with hypovolemia, sepsis, and shock. Anesthetic management strategies should be based on the severity of these presenting conditions and the nature of the planned procedure. Esophageal anastomotic leak is a frequent complication associated with high morbidity and mortality and is likely to be a function of numerous surgical, systemic, and possibly anesthetic factors. Since anastomotic integrity is dependent upon adequate blood flow and oxygen delivery, the development of anastomotic leak may be related to intraoperative management variables, particularly systemic blood pressure, cardiac output, and oxygen delivery and may thus be modifiable by anesthetic management.

Keywords

Lower Esophageal Sphincter Minimally Invasive Esophagectomy Cricoid Pressure Rapid Sequence Induction Thoracic Epidural Analgesia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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

EUS

Endoscopic ultrasound

GDFT

Goal-directed fluid therapy

GERD

Gastroesophageal reflux disease

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

SLT

Single lumen endotracheal tube(s)

TEA

Thoracic epidural analgesia

TEF

Tracheoesophageal fistula

THE

Transhiatal esophagectomy

TTE

Transthoracic esophagectomy

UES

Upper esophageal sphincter

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Randal S. Blank
    • 1
  • Julie L. Huffmyer
    • 2
  • J. Michael Jaeger
    • 3
  1. 1.Department of AnesthesiologyUniversity of VirginiaCharlottesvilleUSA
  2. 2.Department of AnesthesiologyUniversity of Virginia Health SystemCharlottesvilleUSA
  3. 3.Department of Anesthesiology, Divisions of Critical Care Medicine and Cardiothoracic AnesthesiaUniversity of Virginia Health SystemCharlottesvilleUSA

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