Ju-Mei Ng

Update on anesthetic management for esophagectomy.

Purpose of review The article highlights the current important issues surrounding the anesthetic care of patients presenting for esophagectomy. Recent findings With the decline in mortality from esophagectomy in high-volume centers over the last 30 years, focus may now be on decreasing morbidity. Improving the blood supply of the esophageal anastomosis, methods to reduce the incidence of pulmonary complications and optimizing fluid management in these patients are areas in which anesthetic care may contribute. There are also the potential benefits of minimally invasive techniques, which are increasingly being utilized. Summary The incorporation of thoracic epidural analgesia, goal-directed fluid management therapy, protective ventilation during one-lung anesthesia and strategies to improve perfusion of the gastric graft are some aspects which anesthetic care may impact.

Vallecular cyst and laryngomalacia in infants: report of six cases and airway management.

IMPLICATIONS This report describes difficulties encountered in the airway management of six infants with concurrent vallecular cyst and laryngomalacia. It is hoped that our experience will assist others in the management of such patients.

Perioperative Anesthetic Management for Esophagectomy

Esophageal resection is a formidable operation associated with high morbidity and mortality. Anesthetic management may contribute to the containment of respiratory failure and anastomotic leakage by the use of thoracic epidural analgesia, protective ventilation strategies, prevention of tracheal aspiration, and judicious fluid management.

Anesthetic management of patients undergoing extrapleural pneumonectomy for mesothelioma.

Purpose of review Extrapleural pneumonectomy is a radical and aggressive surgery that presents a great challenge to the thoracic anesthesiologist. This surgery is performed routinely by only a few centers in the world and this review represents our institutions experience in anesthetic care. Recent findings Prominent among the developing multimodal treatment options is the combination of extrapleural pneumonectomy with intraoperative intracavitary hyperthermic chemotherapy. Outcome survival benefits have recently been demonstrated for the less completely cytoreductive pleurectomy procedure when combined with intraoperative intracavitary hyperthermic chemotherapy and trials are well under way for extrapleural pneumonectomy plus intraoperative intracavitary hyperthermic chemotherapy. Anesthetic management of extrapleural pneumonectomy is further impacted by these developments. Summary Anesthetic management importantly contributes to containment of the perioperative complications of extrapleural pneumonectomy. An appreciation of the technical aspects and physiologic disruptions associated with extrapleural pneumonectomy is critical to effective management. While data on this relatively uncommon surgical procedure are scarce, some referral centers have accumulated extensive experience. This review summarizes relevant surgical aspects and anesthetic insights from the Brigham and Womens Hospital experience. Included are the anesthetic implications of intraoperative intracavitary hyperthermic chemotherapy in combination with extrapleural pneumonectomy – an emerging therapeutic option in the treatment of malignant pleural mesothelioma.