Achalasia is an idiopathic motility disorder of the oesophagus of increasing incidence. It is characterized by aperistalsis of the lower oesophagus and failure of relaxation of the lower oesophageal sphincter. Patients classically present with chronic symptoms of dysphagia, chest pain, weight loss and regurgitation, and they commonly suffer pulmonary complications such as recurrent microaspiration of static, retained food contents of the upper oesophagus. However, it has also been described, uncommonly, to present with megaoesophagus and secondary tracheal compression. We present a case of megaoesophagus secondary to achalasia which presented with stridor and signs of acute superior vena caval obstruction.

S100B levels, MRS at discharge, and extended Glasgow outcome scale (GOSE) at 1 and 3 months were observed. Results: No statistically significant difference was found with respect to jugular venous oxygen saturation in either group. However, intraoperative hemodynamic parameters were better maintained in patients receiving ketofol compared with those receiving propofol (p < 0.05) with decreased requirement of phenylephrine or mephentermine in ketofol group. There was no statistically significant difference in quality of brain relaxation, preoperative and postoperative ONSD, MRS, GOSE at 1 month and 3 months, SB100 levels, and number of ventilator days in the either group. Conclusions: Ketofol (combination of ketamine and propofol in the ratio 1:5) and propofol similarly maintain cerebral oxygenation. However, hemodynamics appears to be better maintained with ketofol as the maintenance agent.