Anaesthesia and Airway Challenges in Patients with Corrosive Pharyngo-oesophageal Stricture: Experience of a Tertiary Care Centre

Abstract

Background: Ingestion of corrosive substances causes necrosis of the tissues of the upper airway and upper gastrointestinal tract resulting not only in acute airway injuries but also long-term sequelae like strictures. Medical and surgical management of these strictures has been discussed extensively; however, there is little literature available on the anaesthetic management of pharyngo-oesophageal strictures. We hereby discuss our experience in managing these patients undergoing surgical correction. Methods: Out of a total of 57 cases of corrosive ingestion injuries between 2008 and 2016, medical records of 15 patients with complex pharyngeal or high oesophageal strictures undergoing surgical intervention were reviewed. The preoperative findings, the extent of airway involvement and any airway intervention done were noted. Based on the surgical intervention, patients were divided into two groups; Group A included patients undergoing repeated string dilatation and Group B included those undergoing coloplasty. Type of anaesthesia given, details of airway management, intraoperative and postoperative course and complications were noted. Results: Group A consisted of 10 patients who underwent endless string dilatation, and Group B consisted of five patients who underwent coloplasty. In Group A, general anaesthesia with endotracheal intubation was given to all patients except for one patient who was tracheostomised. Two patients had significant glottic narrowing and required a smaller size tube. In Group B, four out of five patients were tracheostomised, while one had a normal glottic opening. General anaesthesia with epidural analgesia was given to all patients. Severe haemodynamic changes were seen during tunnelling through the posterior mediastinum for colonic interposition. All patients were extubated on the table. None of the patients required postoperative ventilatory or inotropic support. Conclusion: Management of corrosive pharyngo-oesophageal strictures is challenging and requires a multidisciplinary approach. Careful assessment and management of the airway, vigilant intraoperative haemodynamic monitoring and good pain management are the key contributions of anaesthesia care.