Anästhesie und klinische Forschung
Offener Zugang

Abstrakt

Airway Protection during Anesthesia for Esophagogastroduodendoscopy in Patients with Achalasia

Medhat Hannallah

Achalasia is a disorder characterized by aperistalsis of the esophageal body and impaired relaxation of the lower esophageal sphincter. Dysphagia and regurgitation of undigested, retained food or accumulated saliva are common presenting symptoms. Recurrent aspiration pneumonia may also occur particularly in older patients [1]. Patients with achalasia are clearly at a high risk for aspiration during general anesthesia. The rapidsequence induction technique with endotracheal intubation and cricoid pressure is, therefore, indicated [2]. This is a report of two patients with achalasia who underwent esophagogastroduodenoscopy (EGD) during general anesthesia which was induced using the rapid-sequence induction technique. The cases illustrate the limitations of the airway protection that this technique offers such high risk patients. The first patient was a 69-yr-old man, ASA physical status III, 120 kg, 175 cm, with a Mallampati class III airway. He was admitted for an EGD for evaluation of dysphagia. Recent radiographs were suggestive of achalasia. Rapid-sequence induction of general anesthesia using propofol and succinyl choline with cricoid pressure was performed with the patient in the supine, head-up position. Some difficulty in visualizing an anteriorly placed larynx was felt to be exaggerated by the cricoid pressure. Gradual release of the cricoid pressure to improve visualization of the larynx was immediately followed by regurgitation of milky fluid from the esophagus into the mouth. Immediate suctioning of the regurgitant fluid was followed by successful endotracheal intubation. The trachea was suctioned and was found to be clear of fluids prior to applying positive pressure ventilation. No evidence of aspiration was found following the procedure.