Gastric Microcirculation and Respiratory Morbidity following esophagectomy

Advances in anesthesia during the last 4 decades have resulted in substantial decreases in morbidity and mortality after surgery. Previously, anesthetists focused mainly on the assessment of anesthetic-related complications and traditional measures of postoperative morbidity. One of the challenges of modern anesthesia is the necessity to contribute to postoperative recovery and quality of life as part of a multidisciplinary team. The starting point for changing perceptions and standardizing approaches to perioperative management lies in improving communication within the team. For the anesthesiologist, this involves attention to the patient’s wishes as well as to perioperative management, ventilation strategies, postoperative pain management, and early mobilization. Similarly, surgeons should be willing to discuss and vary the operative technique according to patient physiology and characteristics. Esophagectomy is a high-risk surgical procedure associated with tremendous postoperative morbidity and mortality and provides a good example of a complicated procedure in which a multidisciplinary approach is required. For these patients, it is unlikely that a single intervention will show a benefit with respect to outcome; an approach that addresses several factors and shows effects on outcome or has promising benefits is necessary. A multimodal approach may improve the infrastructure for management of these patients in high-volume centers, resulting in earlier recognition and better treatment of complications.

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