[Anaesthetic management of oesophagectomy: advances and perspectives].
Oesophagectomy is still characterized by a high postoperative mortality and respiratory morbidity. Nevertheless, epidemiological, medical and surgical advances have improved the management of this surgical procedure. The anaesthesiologist influence is present at each level, from the preoperative evaluation to the management of postoperative complications. The preoperative period is improved by the use of assessment scores, the better knowing of respiratory risk factors and of the neoadjuvant therapy adverse effects. The main objective of the operative period is to ensure a rapid weaning procedure and stability of the respiratory and haemodynamic functions, warranting the anastomotic healing. The interest of the association between respiratory rehabilitation and thoracic epidural analgesia is highlighted in the postoperative period. The management of postoperative complications, mainly represented by respiratory failure and anastomotic leakages, requires a multidisciplinary analysis. The potential interest of non-invasive ventilation and of the modulation of postoperative inflammatory response needs further investigation.
Michelet
P
P
Département d'anesthésie-réanimation, hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, 13009 Marseille, France. pierre.michelet@ap-hm.fr
Jaber
S
S
Eledjam
J-J
JJ
Auffray
J-P
JP
D000767:Anesthesia, Epidural / Q000379:methods*; D016629:Esophagectomy / Q000379:methods*; D006801:Humans; D011183:Postoperative Complications; D018570:Risk Assessment; D015300:Ventilator Weaning; D012122:Ventilators, Mechanical