Published online Nov 6, 2020. doi: 10.12998/wjcc.v8.i21.5409
Peer-review started: June 16, 2020
First decision: July 25, 2020
Revised: August 5, 2020
Accepted: August 20, 2020
Article in press: August 20, 2020
Published online: November 6, 2020
Esophageal cancer is a common malignant tumor of the digestive system. At present, surgery is the most important treatment strategy. After esophagectomy and gastric esophagoplasty, the patients are prone to regurgitation. However, these patients currently do not receive much attention, especially from anesthesiologists.
A 55-year-old woman was scheduled for right lower lung lobectomy. The patient had undergone radical surgery for esophageal cancer under general anesthesia 6 mo prior. Although the patient had fasted for > 17 h, unexpected aspiration still occurred during induction of general anesthesia. Throughout the operation, oxygen saturation was 98%-100%, but the airway pressure was high (35 cmH2O at double lung ventilation). The patient was sent to the intensive care unit after surgery. Bedside chest radiography was performed, which showed exudative lesions in both lungs compared with the preoperative image. After surgery, antibiotics were given to prevent lung infection. On day 2 in the intensive care unit, the patient was extubated and discharged on postoperative day 7 without complications related to aspiration pneumonia.
After esophagectomy, patients are prone to regurgitation. We recommend nasogastric tube placement followed by rapid sequence induction or conscious intubation.
Core Tip: In patients undergoing esophagectomy and gastric esophagoplasty, there is a high risk of aspiration pneumonia during the perioperative period. Aspiration pneumonia is closely related to postoperative mortality and pulmonary complications, so anesthesiologists should pay extra attention to such patients.