[Intraoperative cardiopulmonary disorders during esophagectomy in relation to the surgical technique]

Twenty-one healthy female sheep were anaesthetised in a standard technique with ketamine, dehydrobenzperidol and etomidate. In seven sheep an endoscopic esophagectomy was made (group 1), in seven a blunt esophagectomy (group 2) and in a further seven a thoraco-abdominal esophagectomy (group 3). ECG monitoring, invasive blood pressure measurement, measurement of the central venous pressure and the pulmonary artery pressure with estimation of cardiac output, arterial and mixed venous blood gas analyses were made. The measurement times were: ZDM 1 = preoperative, ZDM 2 = after laparotomy, ZDM 3 = after cervical esophagus preparation or thoracotomy, ZDM 4 = after esophagectomy, ZDM 5 = after inflation of the lungs and ZDM 6 = after a second exploration of the esophagus bed (only groups 1 and 2). Finally the sheep in groups 1 and 2 were thoracotomised on the right side. In group 1 the measurement parameters remained largely unchanged during the entire experiment. In group 2 significant and by the end of the operation irreversible pathological changes occurred immediately after the blunt esophagus resection (ZDM 4): decrease of MAP, paO2 and CO, increase of AaDO2 and PVR. In group 3 similar changes were observed, they began, however, during ZDM 3. The measurement results can be explained in accordance with the operative anatomical findings. How far postoperative pulmonary complications can be avoided in patients with the endoscopic technique must be demonstrated in clinical use.