Anesthetic implications in esophageal replacement surgery: a report of two cases.

Introduction To highlight intraoperative and postoperative challenges in patient with esophageal atresia or stricture undergoing esophageal replacement surgery. We report two such cases and important considerations in its management. Case report: First case. 4 year old child, weighing 16 kgs, with history of corrosive ingestion 1 year back, which lead to development of stricture. He was planned for jejunal transposition surgery. Second case. 18 months old infant, weighing 10 kgs. He had esophageal atresia and esophagostomy and gastrostomy was done on 2nd day of life. Gastric pullup surgery was planned for the patient. In preanesthetic examination no associated congenital anomaly was present. We planned for general anesthesia along with lumbar epidural for intraoperative and postoperative analgesia. Proper oropharyngeal suction was done. After premedication with midazolam and glycopyrrolate, fentanyl 2µg/kg was given. Thiopentone and succinylcholine were used for induction. After endotracheal intubation, lumbar epidural was given in L3-L4 intervertebral space and epidural catheter was inserted followed by 0.2% ropivacaine 0.5 ml/kg bolus. Intraoperatively hypotension occurred in first case but managed successfully with blood transfusion and vasopressors. Postoperatively both patients were shifted intubated to ICU for elective ventilation and kept sedated with midazolam 2µg/kg/min. Analgesia was maintained with epidural 0.2% ropivacaine combined with 0.5µg/kg dexmedetomidine 6 hourly. Both were extubated on 2nd and 3rd postoperative day. Conclusion Esophageal replacement surgery is challenging case for anesthesiologists in various perspects including risk for major blood loss, requirement for adequate intraoperative and postoperative analgesia, pediatric patient and need for postoperative elective ventilation and adequate sedation. Cautious management is required in all these aspects for a favourable patient outcome. [ABSTRACT FROM AUTHOR]