Özofagus Cerrahisi Öncesi Preoperatif Anestezi Değerlendirmesi
Özet
Özofagus cerrahisi, tümörler, gastroözofageal reflü ve akalazya gibi nedenlerle uygulanan ve yüksek morbidite ile mortalite riski taşıyan büyük ameliyatlardandır. Anestezi yönetimindeki en kritik durumlardan biri, özofagus darlığı veya motilite bozuklukları nedeniyle yüksek olan pulmoner aspirasyon riskidir; bu riski azaltmak için preoperatif dönemde ilaç tedavisi, uyanık nazogastrik aspirasyon ve hızlı seri indüksiyon uygulanmalıdır. Ayrıca, hastaların sigara ve alkol kullanımı, KOAH veya karaciğer yetmezliği gibi ciddi komorbiditeleri preoperatif süreçte detaylıca değerlendirilmeli, anemi ve beslenme yetersizlikleri cerrahi öncesinde düzeltilmelidir. Ameliyat sırasında hemodinamik stabiliteyi korumak adına aşırı sıvı yüklemesinden kaçınılmalı, intraoperatif yakın izlem yapılmalı ve tek akciğer ventilasyonu gibi özel hava yolu stratejileri planlanmalıdır. Cerrahi sonrasında gelişebilecek solunum yetmezliği ve pnömoni gibi pulmoner komplikasyonları önlemek için torasik epidural analjezi veya paravertebral blok gibi bölgesel anestezi teknikleriyle optimal ağrı kontrolü sağlanması hayati önem taşımaktadır.
Esophageal surgery is a major procedure performed for indications such as tumors, gastroesophageal reflux, and achalasia, and it carries high morbidity and mortality risks. One of the most critical aspects of anesthesia management is the high risk of pulmonary aspiration due to esophageal strictures or motility disorders; to mitigate this risk, preoperative medication, awake nasogastric aspiration, and rapid sequence induction must be implemented. Additionally, patients' serious comorbidities, including smoking and alcohol use, COPD, or liver disease, must be thoroughly evaluated preoperatively, and issues like anemia and malnutrition should be optimized prior to surgery. To maintain hemodynamic stability during the operation, fluid overload must be avoided, close intraoperative monitoring should be performed, and specialized airway strategies like one-lung ventilation must be planned. Achieving optimal postoperative pain control through regional anesthesia techniques such as thoracic epidural analgesia or paravertebral blockade is vital to prevent respiratory failure and pulmonary complications like pneumonia.
Referanslar
G. Edward Morgan, Jr, MD Maged S. Mikhail, MD Michael J. Murray, MD, PhD, Clinical anesthesiology, LANGE 2005. Anesthesia for thoracic surgery, episode 24.
SEER Stat Fact Sheets: Esophagus; Survival and Stage. seer.cancer.gov/statfacts/html/es oph.html#survival (Accessed on May 01, 2012).
D'Amico TA. Outcomes after surgery for esophageal cancer. Gastrointest Cancer Res 2007; 1:188.
Hirst J, Smithers BM, Gotley DC, Janine Thomas, Andrew Barbour. Defining cure for esophageal cancer: analysis of actual 5-year survivors following esophagectomy. Ann Surg Oncol 2011; 18:1766.
Miyata H, Yamasaki M, Kurokawa Y, Shuji Takiguchi, Kiyokazu Nakajima, Yoshiyuki Fujiwara et al. Multimodal treatment for resectable esophageal cancer. Gen Thorac Cardiovasc Surg 2011; 59:461.
Ajani J, D'Amico TA, Hayman JA, Neal J Meropol, Bruce Minsky, National Comprehensive Cancer Network. Esophageal cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 2003; 1:14.
Myoga Y. Airway Management in Patients With a History of Esophagectomy: A Case Series. J Cardiothorac Vasc Anesth 2020; 34:3063.
Bernard M. Smithers, David C. Gotley, Ian Martin, Janine M. Thomas : Ann Surg 245:232, 2007.
Templeton R, Greenhalgh D. Preoperative rehabilitation for thoracic surgery. Curr Opin Anaesthesiol 2019; 32:23.
Tibi P, McClure RS, Huang J, Robert A Baker , David Fitzgerald , C David Mazer et al. STS/SCA/AmSECT/SABM Update to the Clinical Practice Guidelines on Patient Blood Management. J Cardiothorac Vasc Anesth 2021; 35:2569.
Steinbicker AU. Role of anesthesiologists in managing perioperative anemia. Curr Opin Anaesthesiol 2019; 32:64.
Dhir A, Tempe DK. Anemia and Patient Blood Management in Cardiac Surgery-Literature Review and Current Evidence. J Cardiothorac Vasc Anesth 2018; 32:2726.
Munting KE, Klein AA. Optimisation of pre-operative anaemia in patients before elective major surgery - why, who, when and how? Anaesthesia 2019; 74 Suppl 1:49.
Warner MA, Shore-Lesserson L, Shander A, Sephalie Y Patel , Seth I Perelman , Nicole R Guinn et al. Perioperative Anemia: Prevention, Diagnosis, and Management Throughout the Spectrum of Perioperative Care. Anesth Analg 2020; 130:1364.
Ganz T. Anemia of Inflammation. N Engl J Med 2019; 381:1148.
Raphael J, Mazer CD, Subramani S, Andrew Schroeder , Mohamed Abdalla , Renata Ferreira et al. Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients. Anesth Analg 2019; 129:1209.
Shander A, Kaufman M, Goodnough LT. How I treat anemia in the perisurgical setting. Blood 2020; 136:814.
Warner DO. Perioperative abstinence from cigarettes: physiologic and clinical consequences. Anesthesiology 2006; 104:356.
Turan A, Mascha EJ, Roberman D, Patricia L Turner, Jing You, Andrea Kurz, et al. Smoking and perioperative outcomes. Anesthesiology 2011; 114:837.
Wong J, An D, Urman RD, David O Warner 4, Hanne Tønnesen 5 6, Raviraj Raveendran et al. Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement on Perioperative Smoking Cessation. Anesth Analg 2020; 131:955.
Grønkjær M, Eliasen M, Skov-Ettrup LS, Janne Schurmann Tolstrup, Anne Hjøllund Christiansen, Stine Schou Mikkelsen, et al. Preoperative smoking status and postoperative complications: a systematic review and meta-analysis. Ann Surg 2014; 259:52.
Nolan MB, Martin DP, Thompson R, Darrell R Schroeder 3, Andrew C Hanson 3, David O Warner et al. Association Between Smoking Status, Preoperative Exhaled Carbon Monoxide Levels, and Postoperative Surgical Site Infection in Patients Undergoing Elective Surgery. JAMA Surg 2017; 152:476.
Nordestgaard AT, Rasmussen LS, Sillesen M, Jacob Steinmetz,David R. King,Noelle Saillant et al. Smoking and risk of surgical bleeding: nationwide analysis of 5,452,411 surgical cases. Transfusion 2020; 60:1689.
Vaporciyan AA, Kelly W Merriman MPHa Ferrah Ece MDa Jack A Roth MDa W. Roy Smythe MDa Stephen G Swisher MDet al: Ann Thorac Surg 73:420, 2002
Akrawi W, Benumof JL: J Cardiothorac Vasc Anesth 11:629, 1997
Barrera R, Weiji Shi MSa David Amar MDa, Howard T. Thaler PhDa, Natalie Gabovich MDa, Manjit S. Bains MDb et al: Chest 127:1977, 2005.
Tonnesen H, Kehlet H. Preoperative alcoholism and postoperative morbidity. Br J Surg 1999; 86:869.
Spies C, Tønnesen H, Andreasson S, Anders Helander, Kate Conigvare. Perioperative morbidity and mortality in chronic alcoholic patients. Alcohol Clin Exp Res 2001; 25:164S.
Minnella EM, Awasthi R, Loiselle SE, Ramanakumar V Agnihotram , Lorenzo E Ferri , Francesco Carli . Effect of Exercise and Nutrition Prehabilitation on Functional Capacity in Esophagogastric Cancer Surgery: A Randomized Clinical Trial. JAMA Surg 2018; 153:1081.
Low DE, Allum W, De Manzoni G, Lorenzo Ferri , Arul Immanuel , MadhanKumar Kuppusamy et al. Guidelines for Perioperative Care in Esophagectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations. World J Surg 2019; 43:299.
Inoue J, Ono R, Makiura D, M Kashiwa-Motoyama, Y Miura, M Usami et al. Prevention of postoperative pulmonary complications through intensive preoperative respiratory rehabilitation in patients with esophageal cancer. Dis Esophagus 2013; 26:68.
Silvapulle E, Johnson D, Darvall JN. Risk stratification of individuals undergoing surgery after COVID-19 recovery. Br J Anaesth 2022; 128:e37.
Baumber R, Panagoda P, Cremin J, Flynn P. Risk stratification of individuals undergoing surgery after COVID 19 recovery. Response to Br J Anaesth 2022; 128: e37-9. Br J Anaesth 2022; 128:e57.
Wijeysundera DN, Khadaroo RG. Surgery after a previous SARS-CoV-2 infection: data, answers and questions. Anaesthesia 2021; 76:731.
American Society of Anesthesiologists Committee on Occupational Health: Coronavirus I nformation for Health Care Professionals (Clinical FAQs) https://www.asahq.org/about-asa/governance-and-committees/asa committees/committee-on-occupational-health/cor onavirus/clinical-faqs (Accessed on March 19, 2020).
Peng PWH, Ho PL, Hota SS. Outbreak of a new coronavirus: what anaesthetists should know. Br J Anaesth 2020; 124:497.
Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anaesth 2020; 67:568.
Chen X, Shang Y, S Yao, Liu R and Liu H. Perioperative Care Provider's Considerations in Managing Patients with the COVID-19 Infections. Transl Perioper Pain Med 2020; 7:216.
Thomas-Rüddel D, Winning J, Dickmann P, D Ouart , A Kortgen , U Janssens et al. [Coronavirus disease 2019 (COVID-19): update for anesthesiologists and intensivists March 2020]. Anaesthesist 2020; 69:225.
Donning and doffing personal protective equipment. Centers for Disease Control and Pr evention. https://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf (Accessed on March 24, 2020).
The Use of Personal Protective Equipment by Anesthesia Professionals during the COVID-19 Pandemic. https://www.asahq.org/about-asa/newsroom/news-releases/2020/03/u pdate-the-use-of-personal-protective-equipment-by-anesthesia-professionals-during-the-covid-19 pandemic?_ga=2.184820448.874574752.1585417515-1449346935.158251807 3 (Accessed on March 28, 2020).
Sorbello M, El-Boghdadly K, Di Giacinto I, R Cataldo , C Esposito , S Falcetta et al. The Italian coronavirus disease 2019 outbreak: recommendations from clinical practice. Anaesthesia 2020; 75:724.
Carney A, Dickinson M. Anesthesia for esophagectomy. Anesthesiol Clin 2015; 33:143.
Durkin C, Schisler T, Lohser J. Current trends in anesthesia for esophagectomy. Curr Opin Anaesthesiol 2017; 30:30.
Bartels K, Fiegel M, Stevens Q, Bryan Ahlgren , Nathaen Weitzel. Approaches to perioperative care for esophagectomy. J Cardiothorac Vasc Anesth 2015; 29:472.
Boisen ML, Schisler T, Kolarczyk L, Vladyslav Melnyk , Noah Rolleri , Brandi Bottiger et al. The Year in Thoracic Anesthesia: Selected Highlights from 2019. J Cardiothorac Vasc Anesth 2020; 34:1733.
Lohser J. Evidence-based management of one-lung ventilation. Anesthesiol Clin 2008; 26:241.
Ng RL, Thomson IG, Smithers BM, Booth AWG. Intraoperative fluid restriction during enhanced recovery after surgery versus liberal fluids for esophagectomy: A single center retrospective pilot study. J Clin Anesth 2020; 67:110030.
Durkin C, Schisler T, Lohser J. Current trends in anesthesia for esophagectomy. Curr Opin Anaesthesiol 2017; 30:30.
Chau EH, Slinger P. Perioperative fluid management for pulmonary resection surgery and esophagectomy. Semin Cardiothorac Vasc Anesth 2014; 18:36.
Xing X, Gao Y, Wang H, Shining Qu, Chulin Huang, Hao Zhang, et al. Correlation of fluid balance and postoperative pulmonary complications in patients after esophagectomy for cancer. J Thorac Dis 2015; 7:1986.
Al-Rawi OY, Pennefather SH, Page RD, Ishani Dave, Glen N Russell. The effect of thoracic epidural bupivacaine and an intravenous adrenaline infusion on gastric tube blood flow during esophagectomy. Anesth Analg 2008; 106:884.
Hahm TS, Lee JJ, Yang MK, Kim JA. Risk factors for an intraoperative arrhythmia during esophagectomy. Yonsei Med J 2007; 48:474
Joshi GP, Bonnet F, Shah R, Roseanne C Wilkinson, Frederic Camu, Barrie Fischer et al. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg 2008; 107:1026.
Romero A, Garcia JE, Joshi GP. The state of the art in preventing postthoracotomy pain. Semin Thorac Cardiovasc Surg 2013; 25:116.
Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy--a systematic review and metaanalysis of randomized trials. Br J Anaesth 2006; 96:418
Ding X, Jin S, Niu X, Hao Ren , Shukun Fu , Quan Li. A comparison of the analgesia efficacy and side effects of paravertebral compared with epidural blockade for thoracotomy: an updated metaanalysis. PLoS One 2014; 9:e96233.
Yeung JH, Gates S, Naidu BV, Matthew J A Wilson, Fang Gao Smith. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev 2016; 2:CD009121.
Manion SC, Brennan TJ. Thoracic epidural analgesia and acute pain management. Anesthesiology 2011; 115:181.
Pöpping DM, Elia N, Marret E, Camille Remy, Martin R Tramèr. Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: a meta-analysis. Arch Surg 2008; 143:990.
Werawatganon T, Charuluxanun S. Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. Cochrane Database Syst Rev 2005; :CD004088.
Guay J, Kopp S. Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev 2016; :CD005059.
Li W, Li Y, Huang Q, Shengquan Ye, and Tiehua Rong. Short and Long-Term Outcomes of Epidural or Intravenous Analgesia after Esophagectomy: A Propensity-Matched Cohort Study. PLoS One 2016; 11:e0154380.
Fares KM, Mohamed SA, Hamza HM, Douaa M Sayed, Diab F Hetta. Effect of thoracic epidural analgesia on proinflammatory cytokines in patients subjected to protective lung ventilation during Ivor Lewis esophagectomy. Pain Physician 2014; 17:305.
Heinrich S, Janitz K, Merkel S, Peter Klein, Joachim Schmidt. Short- and long term effects of epidural analgesia on morbidity and mortality of esophageal cancer surgery. Langenbecks Arch Surg 2015; 400:19.
Chen WK, Miao CH. The effect of anesthetic technique on survival in human cancers: a meta-analysis of retrospective and prospective studies. PLoS One 2013; 8:e56540.
Hurford WE, Dutton RP, Alfille PH, D Clement, R S Wilson. Comparison of thoracic and lumbar epidural infusions of bupivacaine and fentanyl for post-thoracotomy analgesia. J Cardiothorac Vasc Anesth 1993; 7:521.
Wei Zhang , Cai Fang , Juan Li , Qing-Tian Geng , Song Wang , Fang Kang et al. Single-dose, bilateral paravertebral block plus intravenous sufentanil analgesia in patients with esophageal cancer undergoing combined thoracoscopic-laparoscopic esophagectomy: a safe and effective alternative. J Cardiothorac Vasc Anesth 2014; 28:966.
Chan VW, Chung F, Cheng DC C. Seyone A. Chung T. Kirby. Analgesic and pulmonary effects of continuous intercostal nerve block following thoracotomy. Can J Anaesth 1991; 38:733.
Dryden CM, McMenemin I, Duthie DJ. Efficacy of continuous intercostal bupivacaine for pain relief after thoracotomy. Br J Anaesth 1993; 70:508.
Khalil AE, Abdallah NM, Bashandy GM, Kaddah TA. Ultrasound-Guided Serratus Anterior Plane Block Versus Thoracic Epidural Analgesia for Thoracotomy Pain. J Cardiothorac Vasc Anesth 2017; 31:152.
Jack JM, McLellan E, Versyck B, M F Englesakis , K J Chin. The role of serratus anterior plane and pectoral nerves blocks in cardiac surgery, thoracic surgery and trauma: a qualitative systematic review. Anaesthesia 2020; 75:1372.
Levy G, Cordes MA, Farivar AS,Aye RW,Louie BE. Transversus Abdominis Plane Block Improves Perioperative Outcome After Esophagectomy Versus Epidural. Ann Thorac Surg 2018; 105:406.
White PF, Kehlet H. Improving postoperative pain management: what are the unresolved issues? Anesthesiology 2010; 112:220.
Kehlet H, Wilkinson RC, Fischer HB, Camu F, Prospect Working Group. PROSPECT: evidence-based, procedure-specific postoperative pain management. Best Pract Res Clin Anaesthesiol 2007; 21:149.
Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol 2009; 22:588.
Sudarshan G, Browne BL, Matthews JN, Conacher ID. Intrathecal fentanyl for postthoracotomy pain. Br J Anaesth 1995; 75:19.
Gray JR, Fromme GA, Nauss LA, J K Wang, D M Ilstrup. Intrathecal morphine for post-thoracotomy pain. Anesth Analg 1986; 65:873.
Mason N, Gondret R, Junca A, Bonnet F. Intrathecal sufentanil and morphine for postthoracotomy pain relief. Br J Anaesth 2001; 86:236.
Steinthorsdottir KJ, Wildgaard L, Hansen HJ, Petersen RH, Wildgaard K. Regional analgesia for video-assisted thoracic surgery: a systematic review. Eur J Cardiothorac Surg 2014; 45:959.
Shanthanna H, Moisuik P, O'Hare T, Srinathan S, Finley C, James Paul et al. Survey of Postoperative Regional Analgesia for Thoracoscopic Surgeries in Canada. J Cardiothorac Vasc Anesth 2018; 32:1750.
Wittenstein J, Ball L, Pelosi P, Gama de Abreu M. High-flow nasal cannula oxygen therapy in patients undergoing thoracic surgery: current evidence and practice. Curr Opin Anaesthesiol 2019; 32:44.
Michelet P, D'Journo XB, Seinaye F, J M Forel, L Papazian, P Thomas. Non-invasive ventilation for treatment of postoperative respiratory failure after oesophagectomy. Br J Surg 2009; 96:54.
Schaheen L, Blackmon SH, Nason KS. Optimal approach to the management of intrathoracic esophageal leak following esophagectomy: a systematic review. Am J Surg 2014; 208:536.
