Anaes · Thoracic anaesthesia
Anaesthesia for oesophagectomy
Also known as Esophagectomy anaesthesia · Ivor Lewis anaesthesia · MIE OLV oesophagectomy
Exam-pass oesophagectomy anaesthesia: two-cavity physiology, lung isolation, fluid and anastomotic concerns, thoracic analgesia, aspiration risk, and ERAS-leaning postop care for ANZCA Final.
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Red flags
- Aspiration risk remains high — treat as shared airway/full stomach thinking when indicated.
- One-lung ventilation hypoxaemia needs a structured algorithm — not random PEEP wars.
- Fluid overload may harm lungs and anastomosis perfusion balance is nuanced.
- Anastomotic leak is a delayed killer — protect conduit perfusion.
- RLN injury and recurrent aspiration after extubation.
Meet the patient
A 62-year-old with oesophageal cancer presents for Ivor Lewis oesophagectomy after neoadjuvant chemoradiotherapy. He has lost twelve kilograms, his albumin is low, he has reflux and dysphagia, and he smoked for forty years. The HDU bed is booked and the left double-lumen tube is on the tray.[1]
The two questions that run an oesophagectomy: is the lung isolated and confirmed, and is the conduit perfused? Everything below — airway, ventilation, fluids, analgesia, and postoperative surveillance — answers one of those two.[1]
References3ShowHide
- [1]Veelo DP, Geerts BF Anaesthesia during oesophagectomy J Thorac Dis, 2017.PMID 28815066
- [2]Deana C, Vetrugno L, Bignami E, Bassi F Peri-operative approach to esophagectomy: a narrative review from the anesthesiological standpoint J Thorac Dis, 2021.PMID 34795950
- [3]Nightingale CE, Margarson MP, Shearer E, et al. Peri-operative management of the obese surgical patient 2015: Association of Anaesthetists of Great Britain and Ireland Society for Obesity and Bariatric Anaesthesia Anaesthesia, 2015.PMID 25950621