Tang JX, Wang L, Nian WQ, Tang WY, Xiao JY, Tang XX, Liu HL. Aspiration pneumonia during general anesthesia induction after esophagectomy: A case report. World J Clin Cases 2020; 8(21): 5409-5414 [PMID: 33269277 DOI: 10.12998/wjcc.v8.i21.5409]
Corresponding Author of This Article
Hong-Liang Liu, MD, Chief Doctor, Department of Anesthesiology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing 400030, China. liuhl75@163.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jia-Xi Tang, Jing-Yu Xiao, Xi-Xi Tang, Hong-Liang Liu, Department of Anesthesiology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400030, China
Ling Wang, Wei-Qi Nian, Wan-Yan Tang, Department of Phase I Clinical Trial Ward, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400030, China
Author contributions: Tang JX was the anesthesiologist and wrote the manuscript; Tang JX, Wang L, Nian WQ, Tang WY and Xiao JY conceived and designed the report; Tang JX and Tang XX collected and prepared the images; Liu HL reviewed and confirmed the final version of the manuscript; All authors have read and approve the final manuscript.
Supported byNatural Science Foundation of Chongqing, China, No. CSTC2019JCYJ-MSXMX0623.
Informed consent statement: The patient involved in this study gave written informed consent authorizing the use and disclosure of his protected health information. The study protocol was approved without restrictions by the Medical Ethics Committee of the Institute of Chongqing University Cancer Hospital.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hong-Liang Liu, MD, Chief Doctor, Department of Anesthesiology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing 400030, China. liuhl75@163.com
Received: June 16, 2020 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 Processing time: 142 Days and 18.5 Hours
Abstract
BACKGROUND
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.
CASE SUMMARY
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.
CONCLUSION
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.
