[Cancer and esophagobronchial fistula: a case report]

Palliative esophageal bypass surgery for patients with esophageal cancer and esophagobronchial fistula aims restoring the ability of swallowing as well as preventing pulmonary aspiration. Perioperatively, there are several problems in respiratory management for such patients. Repeated episodes of pulmonary aspiration exaggerate bronchopneumonia. Positive pressure ventilation may cause air leakage via fistula resulting in inadequate ventilation, distension of the stomach and regurgitation of gastric contents; thus, maintaining of spontaneous ventilation is a crucial concern. Here we report an anesthetic management of a 51-year-old woman with esophageal cancer and esophagobronchial fistula undergoing esophageal bypass surgery. We could not apply neuraxial block due to hypocoagulability. We performed awake tracheal intubation, and general anesthesia was maintained using sevoflurane supplemented by morphine, fentanyl and ketamine under spontaneous ventilation until the resection of gastroesophageal junction and the installation of a drainage catheter into the esophagus. Muscle relaxation required for surgery was sufficiently obtained by sevoflurane anesthesia without administration of muscle relaxants. After the installation of the drainage catheter, the lungs were ventilated mechanically until the end of surgery. The surgery was uneventful. The patient emerged from general anesthesia smoothly, and was extubated. The postoperative course of this patient was also uneventful.