Pulmonary morbidity following esophagectomy is decreased after introduction of a multimodal anesthetic regimen.

Respiratory morbidity is the most frequent complication after esophagectomy, which can occur in 50% of the patients treated for esophageal cancer. We tested the hypothesis whether an anesthetic regimen, emphasizing intraoperative fluid restriction and early extubation could, positively influence postoperative morbidity, without affecting the gastric tube reconstruction. We introduced an anesthetic regimen, based on early extubation and a controlled intraoperative fluid management (net fluid balance < 4 L) in combination with the use of norepinephrine to maintain mean arterial blood pressure > 65 mmHg. Postoperative morbidity and mortality were compared with a similar group of patients operated one year before. From June 2005 till September 2006, 83 patients were treated according to the new regimen (NR) and compared to a similar number of patients from the same period in 2003-2005 (standard regimen: SR). Applying the NR resulted in significantly less fluid administration (balance of 3.5 +/- 0.2 L NR vs. 5.1 +/- 0.2 L SR, p < 0.05) resulting in fewer patients developing pneumonia (26% in the NR group vs. 42% in the SR group, p < 0.05). Similar per operative blood loss and urine output and occurrence of leakage or ischemia of the gastric tube anastomosis occurred in both groups. Respiratory morbidity is significantly reduced with the introduction of a new anesthetic regimen directed at intraoperative fluid restriction and early extubation, without increasing anastomotic leakage of the gastric tube reconstruction.