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Chapter 9 - Upper gastrointestinal cases

Published online by Cambridge University Press:  05 July 2014

Mark Abrahams
Affiliation:
Addenbrooke’s Hospital, Cambridge
Richard Hardwick
Affiliation:
Addenbrooke’s Hospital, Cambridge
Jane Sturgess
Affiliation:
Addenbrooke’s Hospital, Cambridge
Justin Davies
Affiliation:
Addenbrooke’s Hospital, Cambridge
Kamen Valchanov
Affiliation:
Papworth Hospital, Cambridge
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Summary

Introduction

The range of surgical procedures, the potential anatomical hazards, and the problems associated with patient co-morbidities make upper gastrointestinal surgery a stimulating specialty for surgeon and anaesthetist. In recent years, the near-universal move towards minimally invasive surgery and early ambulation have been mirrored in upper GI surgery, providing further challenges for the surgical team.

The cases demonstrated here are not meant to reflect the vast range of upper GI surgical procedures, but highlight particular anaesthetic challenges associated with this type of surgery. Case 1 discusses the anaesthetic management of laparoscopic surgery, with specific concerns relating to the management of analgesia and post-operative nausea and vomiting. Case 2 discusses upper GI surgery in the morbidly obese, an increasingly common problem for surgeons generally, particularly in the developed world, and especially relevant to the upper GI surgeon practising bariatric surgical techniques. The final case focuses on the management of the patient undergoing oesophagectomy, and discusses the practical management, physiology and evidence-based rationale for treatment; from pre-operative anaesthetic assessment of the patient to post-surgical care in the high-dependency or intensive care setting.

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Publisher: Cambridge University Press
Print publication year: 2014

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References

Blencowe, NS, Strong, S, et al. Reporting of short-term clinical outcomes after esophagectomy: a systematic review. Annals of Surgery 2012; 255(4): 658–66.CrossRefGoogle ScholarPubMed
Fischer, L. Thoracic anesthesia. Current Opinion in Anaesthesiology 2011; 24: 1–48.CrossRefGoogle ScholarPubMed
Martin, RF (ed). Contemporary management of esophageal malignancy. Surgical Clinics of North America 2012; 92(5): 1077–353.CrossRefGoogle ScholarPubMed
National oesophago-gastric cancer audit – 2012 annual report. .
Schumann, R. Anaesthesia for bariatric surgery. Best practice and research. Clinical Anaesthesiology 2011; 25(1): 83–93.Google Scholar
Schumann, R, Jones, SB, et al. Update on best practice recommendations for anesthetic peri-operative care and pain management in weight loss surgery, 2004–2007. Obesity 2009; 17(5): 889–994.CrossRefGoogle Scholar

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