Acute lung injury after oesophagectomy is well recognized but the risk factors associated with its development are poorly defined. We analysed retrospectively the effect of a number of pre-, peri- and post-operative risk factors on the development of lung injury in 168 patients after elective oesophagectomy performed at a single centre. The acute respiratory distress syndrome (ARDS) developed in 14.5% of patients and acute lung injury in 23.8%. Mortality in patients developing ARDS was 50% compared with 3.5% in the remainder. Features associated with the development of ARDS included a low pre-operative body mass index, a history of cigarette smoking, the experience of the surgeon, the duration of both the operation and of one-lung ventilation, and the occurrence of a post-operative anastomotic leak. Peri-operative cardiorespiratory instability (measured by peri-operative hypoxaemia, hypotension, fluid and blood requirements and the need for inotropic support) was also associated with ARDS. Acute lung injury after elective oesophagectomy is associated with intraoperative cardiorespiratory instability.

No abstract

The formation of an acquired tracheooesophageal fistula (TOF) is a rare but serious complication of malignancy and trauma. An established patent tract from the airway to the upper-gastrointestinal tract bypasses the normal protection offered by the laryngeal reflexes. As a consequence, this situation can present the anaesthetist with significant difficulties. The proximity of the oesophagus, trachea, upper mediastinal contents and large blood vessels can further complicate surgery and anaesthesia. 1 Please see multiple choice questions 11-13.

Summary

No abstract