Airway Management in Patients With a History of Esophagectomy: A Case Series

Abstract

Esophagectomy is a highly invasive surgery, and it often is accompanied by various postoperative complications. With increases in the rate and length of patient survival in postoperative esophagectomy patients, the number of said patients receiving subsequent surgeries is increasing. However, airway management in post-esophagectomy patients is yet to be researched widely. This study used anesthesia records from the Kitakyushu Municipal Medical Center to examine airway conditions and complications in patients who had undergone 1 or more additional surgeries following an esophagectomy. Case series. Single center in Japan. Forty-one post-esophagectomy patients from August 2010 to July 2019. None. Forty-one post-esophagectomy patients underwent 58 surgeries. Two of the cases (3%) involved retrosternal reconstruction, and in each, reflux from the gastric conduit was observed during tracheal intubation. The author determined that, in both cases, the gastric conduit was located laterally to the trachea, was sandwiched between both lungs, and was located ventrally to the oral cavity. There were no cases ofaspiration. The possibility of aspiration-especially in cases of retrosternal reconstruction-should be considered in post-esophagectomy patients. Based on computed tomography findings, rapid- sequence induction with head-up position is recommended. Conversely, lung ventilation (inflation) and routine cricoid pressure may be less effective or, in some patients, even harmful.