Anesthetic Management for Esophageal Stent Placement in an Endoscopy Unit Outside Operating Room

Esophageal stent placement is a minimally invasive procedure for treatment of esophageal strictures that cannot be treated with surgical procedure. It requires some forms of anesthesia. This procedure could be performed in the operating room and in the endoscopy unit.

The study is aimed to report and evaluate the choices and techniques, drugs used and complications of anesthesia in the patients undergoing esophageal stent placement procedure in an endoscopy unit outside the operating room in a developing country.

Retrospectively analyzed the patients on whom esophageal stent placement had been performed during the period of January, 2010 to December, 2012 in Siriraj Hospital in Thailand. The patients' characteristics, pre-anesthetic problems, anesthetic techniques, drugs, duration of anesthesia, and anesthesia-related complications were assessed and summarized by using descriptive statistics.

During the study period, there were 48 procedures. Mean age 63.7 ± 13.4 years. The majority of them was male (72.9%) and classified in ASA physical status II (52.1%). Mean duration of anesthesia was 60.6 ± 36.1 minutes. Most common pre-anesthetic problems were hematologic disease (64.6%), electrolyte imbalance (50.0%), respiratory disease (31.3%) and hypertension (29.2%). General anesthesia with endotracheal tube (64.6%) was the main anesthetic technique. The mainly used sedoanalgesic agents were propofol, fentanyl and midazolam. The most common neuromuscular blocking drugs were succinylcholine and atracurium. Additionally, sevoflurane was the most inhalation agent. The overall anesthesia-related complication rate was 35.4%. Hypotension (31.3%) was the most frequent anesthetic complication.

All of the esophageal stent placement procedures, general anesthesia and intravenous sedation techniques could be performed effectively in the appropriate patients. However, clinical signs should be carefully observed and the anesthetic personnel had to optimize the patient's condition for safety and beware of complications.