Thoracic epidural anaesthesia for thoracotomy, oesophageal myotomy and cystotomy-capitonnage in an elderly patient wıth achalasia due to scleroderma☆

Received 20 April 2006; received in revised form 9 November 2006; accepted 20 November 2006.

Summary

An 83-year-old man was hospitalised for achalasia unresponsive to pneumatic dilations. Preoperative CT imaging revealed the dilated oesophagus in addition to multiple left lung hydatid cysts. The present case describes the perioperative anaesthetic and anaesthetic management of a patient with achalasia due to scleroderma undergoing continuous thoracic epidural blockade using 10mL of bupivacaine 0.5%+50mcg fentanyl combined with 1.5% sevoflurane in 50% air+50% oxygen without neuromuscular blockade and without intravenous opioids for left thoracotomy; myotomy and cystotomy-capitonnage for cysts were carried out at the same session. This anesthetic technique provided good intraoperative relaxation followed by an uneventful recovery and eliminated the need for other postoperative analgesics.

Keywords: Continuous thoracic epidural blockade, General anaesthesia, Sevoflurane, Scleroderma, Achalasia, Cyst hydatid, Thoracotomy, Myotomy, Cystotomy-capitonnage

Kocatepe University, School of Medicine, Department of Anaesthesiology and Reanimation, Afyonkarahisar, Turkey

Correspondence address: Dumlupinar Mah. Hüseyin Tevfik Cad. No.: 11/8 03200 Afyonkarahisar, Turkey. Tel.: +90 542 4308744; fax: +90 272 2133066.

☆ Presented in part at the European Society of Regional Anaesthesiology III. Congress in Izmir, Turkey, 13–15 January, 2005.

PII: S1366-0071(06)00205-1

doi:10.1016/j.acpain.2006.11.002

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