Tabrizi Nika Samadzadeh, Shapeton Alexander D, Ortoleva Jamel, Musuku Sridhar R, Schumann Roman
Department of Cardiothoracic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, 44113, USA.
Department of Anesthesia, Veterans Affairs Boston Healthcare System, Critical Care and Pain Medicine, and Tufts University School of Medicine, Boston, MA, 02111, USA.
J Anesth. 2025 Feb;39(1):83-92. doi: 10.1007/s00540-024-03432-3. Epub 2024 Nov 18.
Following esophagectomy, annually several thousand patients in the United States (US) reach a stable post-esophagectomy status. Such patients may require general anesthesia (GA) for elective procedures, but no generally accepted guidelines exist for the induction of GA in post-esophagectomy patients.
A national survey describing a post-esophagectomy patient was emailed to 23,524 attending anesthesiologists who were members of the American Society of Anesthesiologists. The survey included 3 demographic and 12 anesthetic management questions. Responses were further stratified by gender, years in practice and frequency of exposure to the patient population of interest.
A total of 744 (3.2%) respondents completed the survey. The respondent demographic characteristics closely reflected recent US anesthesiology workforce analyses. Endotracheal tube was the preferred method of airway management for 648 (87.1%), 419 (64.7%) used a rapid sequence induction, and 504 (67.7%) elected a reverse Trendelenburg position, with the latter two choices being favored among anesthesiologists with routine (vs. rarely/never) exposure to post-esophagectomy patients (76.6% vs. 58.4%; p < 0.001; and 73.6% vs. 63.9%; p = 0.021, respectively). Across survey participants, induction of GA was highly variable with differential effects of gender, years in practice and exposure frequency to post-esophagectomy patients.
US attending anesthesiologists' approach to induction of GA in a patient with a history of successful esophagectomy was not uniform. The majority of responses reflected a concern for aspiration in such a patient. Considering surgical and non-surgical upper gastrointestinal changes, establishment of practice guidance to optimize perioperative care is an unmet need.
在美国，每年有数千例患者在接受食管切除术后达到稳定的术后状态。这类患者可能需要接受全身麻醉（GA）以进行择期手术，但目前尚无普遍接受的针对食管切除术后患者进行全身麻醉诱导的指南。
一项描述食管切除术后患者情况的全国性调查通过电子邮件发送给了23524名美国麻醉医师协会的在职麻醉医师。该调查包含3个人口统计学问题和12个麻醉管理问题。回复还根据性别、从业年限以及接触目标患者群体的频率进行了进一步分层。
共有744名（3.2%）受访者完成了调查。受访者的人口统计学特征与近期美国麻醉学劳动力分析结果密切相符。648名（87.1%）受访者首选气管内插管作为气道管理方法，419名（64.7%）采用快速顺序诱导，504名（67.7%）选择头高足低位，后两种选择在常规（而非很少/从不）接触食管切除术后患者的麻醉医师中更受青睐（分别为76.6%对58.4%；p<0.001；以及73.6%对63.9%；p=0.021）。在所有参与调查者中，全身麻醉诱导方法差异很大，且存在性别、从业年限以及接触食管切除术后患者频率的不同影响。
美国在职麻醉医师对有成功食管切除术病史患者进行全身麻醉诱导的方法并不统一。大多数回复反映出对这类患者误吸的担忧。考虑到手术和非手术引起的上消化道变化，制定优化围手术期护理的实践指南是一项未得到满足的需求。
