Anesthetic Management of Esophagectomy using one Lung Ventilation

Abstract

Introduction: Esophagectomy is considered as procedure with highest morbidity and mortality; yet one of the main stream treatment for esophageal cancers. Genetics, age, sex, gender are unmodifiable risk factors for esophageal cancers, it is one of the most common cancers occurring in the world. Most important features of oesophagectomy are perioperative risk assessment, pulmonary morbidity, ventilation strategies, thoracic epidural analgesia, goal directed fluid therapy, ERAS protocol, management of cardiovascular complications. Thoracic epidural analgesia helps in reducing the systemic inflammatory response, by decreasing pain stimulus and post-operative pain control. Case Report: A 62 year old, 50 kgs man was posted for transthoracic esophagectomy presented with complaints of difficulty in swallowing and generalized weakness. Patient medical history was not significant. Patient had received 4 cycles chemotherapy (paclitaxel and carboplatin). Anaesthetic management was planned with the aim of proper analgesia, minimum respiratory complications following ERAS protocol. Conclusion: Pre-operative anesthesiological evaluation is mandatory in order to stratify and optimize any medical condition. During surgery, protective ventilation and judicious fluid management are the cornerstones of intraoperative “protective anesthesia”. Post-operative care should be provided by an intensive care unit or high-dependency unit depending on the patient’s condition, the type of surgery endured and the availability of local resources.