Post-ESOphagectomy patients presenting for General Anesthesia INduction: A systematic review of the literature (PESO-GAIN-R)
Purpose: Immediately following esophagectomy, aspiration is responsible for most direct postoperative complications, largely attributed to anatomical alterations from the surgical procedure. The long-term risk of aspiration following successful esophagectomy has not been systematically investigated,...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2025-07-01
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| Series: | Saudi Journal of Anaesthesia |
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| Online Access: | https://journals.lww.com/10.4103/sja.sja_738_24 |
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| author | Nika Samadzadeh Tabrizi Alexander D. Shapeton Jamel Ortoleva Michelle Burmistova Riley A. Demos Sridhar R. Musuku Roman Schumann |
| author_facet | Nika Samadzadeh Tabrizi Alexander D. Shapeton Jamel Ortoleva Michelle Burmistova Riley A. Demos Sridhar R. Musuku Roman Schumann |
| author_sort | Nika Samadzadeh Tabrizi |
| collection | DOAJ |
| description | Purpose:
Immediately following esophagectomy, aspiration is responsible for most direct postoperative complications, largely attributed to anatomical alterations from the surgical procedure. The long-term risk of aspiration following successful esophagectomy has not been systematically investigated, and there are no guidelines for the anesthetic management of postesophagectomy patients who require elective surgeries involving general anesthesia (GA).
Methods:
PubMed/MEDLINE, Embase, and Web of Science were systematically searched from inception through January 1, 2024 to identify studies involving patients ≥90 days postesophagectomy and undergoing elective surgery unrelated to their esophagectomy status, where GA was required. Data on perioperative anesthetic management were extracted. The primary outcomes assessed were perioperative gastrointestinal and pulmonary complications. Secondary outcomes included the approach to induction of GA and author recommendations.
Results:
Of the 4097 studies, ten studies involving 131 patients met inclusion criteria. Intraoperatively, adverse events during induction occurred in 13.0% of 131 cases, including regurgitation of gastric contents in 5.3% and pulmonary aspiration in 9.9%. The airway was managed with an endotracheal tube in 95.6%. Induction was performed in the semi-Fowler position in 92.9% and performed using the rapid sequence and standard induction techniques in 58.7% and 41.3%, respectively.
Conclusions:
Patients who have undergone esophagectomy may remain at high risk for aspiration during GA even in the long term, necessitating enhanced vigilance in anesthetic management. We offer evidence-informed suggestions for elective induction of GA in patients with a history of successful esophagectomy to enhance safe practice for these patients. |
| format | Article |
| id | doaj-art-2c5d0894a5e44e7aa0cf72e67018f4f5 |
| institution | Matheson Library |
| issn | 1658-354X 0975-3125 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Saudi Journal of Anaesthesia |
| spelling | doaj-art-2c5d0894a5e44e7aa0cf72e67018f4f52025-07-04T10:29:18ZengWolters Kluwer Medknow PublicationsSaudi Journal of Anaesthesia1658-354X0975-31252025-07-0119333434410.4103/sja.sja_738_24Post-ESOphagectomy patients presenting for General Anesthesia INduction: A systematic review of the literature (PESO-GAIN-R)Nika Samadzadeh TabriziAlexander D. ShapetonJamel OrtolevaMichelle BurmistovaRiley A. DemosSridhar R. MusukuRoman SchumannPurpose: Immediately following esophagectomy, aspiration is responsible for most direct postoperative complications, largely attributed to anatomical alterations from the surgical procedure. The long-term risk of aspiration following successful esophagectomy has not been systematically investigated, and there are no guidelines for the anesthetic management of postesophagectomy patients who require elective surgeries involving general anesthesia (GA). Methods: PubMed/MEDLINE, Embase, and Web of Science were systematically searched from inception through January 1, 2024 to identify studies involving patients ≥90 days postesophagectomy and undergoing elective surgery unrelated to their esophagectomy status, where GA was required. Data on perioperative anesthetic management were extracted. The primary outcomes assessed were perioperative gastrointestinal and pulmonary complications. Secondary outcomes included the approach to induction of GA and author recommendations. Results: Of the 4097 studies, ten studies involving 131 patients met inclusion criteria. Intraoperatively, adverse events during induction occurred in 13.0% of 131 cases, including regurgitation of gastric contents in 5.3% and pulmonary aspiration in 9.9%. The airway was managed with an endotracheal tube in 95.6%. Induction was performed in the semi-Fowler position in 92.9% and performed using the rapid sequence and standard induction techniques in 58.7% and 41.3%, respectively. Conclusions: Patients who have undergone esophagectomy may remain at high risk for aspiration during GA even in the long term, necessitating enhanced vigilance in anesthetic management. We offer evidence-informed suggestions for elective induction of GA in patients with a history of successful esophagectomy to enhance safe practice for these patients.https://journals.lww.com/10.4103/sja.sja_738_24airway managementanesthesia in esophagectomyaspiration on inductionesophagectomy |
| spellingShingle | Nika Samadzadeh Tabrizi Alexander D. Shapeton Jamel Ortoleva Michelle Burmistova Riley A. Demos Sridhar R. Musuku Roman Schumann Post-ESOphagectomy patients presenting for General Anesthesia INduction: A systematic review of the literature (PESO-GAIN-R) Saudi Journal of Anaesthesia airway management anesthesia in esophagectomy aspiration on induction esophagectomy |
| title | Post-ESOphagectomy patients presenting for General Anesthesia INduction: A systematic review of the literature (PESO-GAIN-R) |
| title_full | Post-ESOphagectomy patients presenting for General Anesthesia INduction: A systematic review of the literature (PESO-GAIN-R) |
| title_fullStr | Post-ESOphagectomy patients presenting for General Anesthesia INduction: A systematic review of the literature (PESO-GAIN-R) |
| title_full_unstemmed | Post-ESOphagectomy patients presenting for General Anesthesia INduction: A systematic review of the literature (PESO-GAIN-R) |
| title_short | Post-ESOphagectomy patients presenting for General Anesthesia INduction: A systematic review of the literature (PESO-GAIN-R) |
| title_sort | post esophagectomy patients presenting for general anesthesia induction a systematic review of the literature peso gain r |
| topic | airway management anesthesia in esophagectomy aspiration on induction esophagectomy |
| url | https://journals.lww.com/10.4103/sja.sja_738_24 |
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