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Respiratory complications after oesophageal surgery

McKevith, James M; Pennefather, Stephen H

Current Opinion in Anaesthesiology:
doi: 10.1097/ACO.0b013e328333b09b
Thoracic anesthesia: Edited by Javier Campos
Abstract

Purpose of review: The most frequent complications of oesophageal surgery are respiratory and these are associated with increased critical care stay, hospital stay and mortality. This review focuses on the risk factors associated with the development of respiratory complications after oesophageal surgery.

Recent findings: An acceptable operative mortality, increased and improved quality of life can be gained in appropriately selected patients. When induction therapy is scheduled, smoking cessation is advised. The preoperative treatment of airway pathogens can reduce postoperative complications and this may be particularly relevant in patients who have received induction chemoradiotherapy. Nonrandomized studies suggest that thoracic epidural analgesia improves outcome. Minimally invasive surgery is increasingly used and appears safe but direct comparisons to open surgery in terms of respiratory complications are awaited. Few randomized studies are available to guide anaesthetic management but anaesthetists should aim to avoid hypoxaemia, hypotension, aspiration and limit blood and fluid administration. Postoperative aspiration is common and steps to reduce it are recommended.

Summary: The multifactorial nature of respiratory complications after oesophageal surgery may mean that a number of interventions are needed to have a detectable influence on outcome, much like a care bundle strategy.

Author Information

Department of Anaesthesia, Liverpool Heart and Chest Hospital NHS Trust, Thomas Drive, Liverpool, UK

Correspondence to Stephen H. Pennefather, MRCP, FRCA, Department of Anaesthesia, Liverpool Heart and Chest Hospital NHS Trust, Thomas Drive, Liverpool L14 3PE, UK Tel: +44 151 600 1616; fax: +44 151 600 1405; e-mail: stephen.pennefather@lhch.nhs.uk

© 2010 Lippincott Williams & Wilkins, Inc.