Anesthesia Considerations for Patients With Severe Achalasia

Area of Science:

• Anesthesiology
• Gastroenterology
• Critical Care Medicine

Background:

• Achalasia, an autoimmune disorder, impairs esophageal motility and lower esophageal sphincter relaxation, leading to dysphagia.
• Aspiration is a significant risk for patients with achalasia, complicating anesthesia management.
• This case involves a 47-year-old woman with achalasia presenting for esophagogastroduodenoscopy.

Purpose of the Study:

• To examine a severe case of achalasia requiring unconventional treatment.
• To emphasize the importance of high suspicion for aspiration risk in achalasia patients.
• To highlight the necessity of collaboration between anesthesia and gastroenterology teams.

Main Methods:

• A 47-year-old female patient with achalasia presented with dysphagia.
• Anesthesia care team opted for general anesthesia with rapid sequence induction.
• Video laryngoscopy revealed a pool of saliva and food particles in the oropharynx.

Main Results:

• Severe aspiration risk was identified in the achalasia patient.
• Unconventional treatment was required for this severe case.
• Effective airway protection was achieved through careful anesthetic management.

Conclusions:

• Maintaining a high index of suspicion for aspiration is crucial in achalasia patients.
• Collaboration between anesthesia and gastroenterology is vital for safe patient management.
• This case underscores the challenges and importance of managing airways in patients with achalasia.