Abstract
Anaesthesia for oesophageal surgery presents a variety of challenges. Thenutritional state of the patient ranges from the cachectic to the obese. Secondary pulmonary pathology is common. Operative procedures range from endoscopy to major thoracoabdominal procedures lasting many hours. Many patients are elderly, and may be suffering from incurable cancer. However, surgery is often indicated in order to improve the quality of their remaining life. Careful preoperative assessment and preparation of the patient is essentialif postoperative complications are to be minimized. Almost all patients must be considered to be at risk of regurgitation and pulmonary aspiration of gastric or oesophageal contents, and rapid-sequence induction of anaesthesia is required. Intraoperatively, severe hypoxaemia may occur during thoracic procedures, and there is a high incidence of cardiovascular complications. The use of appropriate monitoring techniques is important. In the postoperative period, atelectasis and pulmonary infection are common. Adequate pain relief must be ensured, and intensive physiotherapy provided.
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