Journal of Anaesthesia & Critical Care Case Reports

Vol 4 | Issue 2 | May-Aug 2018 | page: 27-29 | Chetan Mehra, Atish Pal

Authors: Chetan Mehra [1], Atish Pal [1]

[1] Department of Anesthesia and Critical care, Indraprastha Apollo Hospitals, New Delhi.

Address of Correspondence
Dr. Atish Pal,
Department of Anesthesia and Critical care,
Indraprastha Apollo Hospitals, New Delhi.
Email : dr_atishpal@yahoo.co.in

Abstract

Introduction: A case of incapacitating mediastinal stretch pain and hemodynamic compromise, caused by a non-displaced, non-functional acutely kinked naso-gatsric tube (NGT). Post-operative esophagectomy patient started complaining of severe retrosternal pain after 2 h. Epidural boluses of bupivacaine and other intravenous analgesics were given with no relief. After some time, the patient went into atrial fibrillation and subsequent hypotension. Chest X-ray revealed mediastinal shadow caused by distended neoesophagus, and NGT was found to be acutely kinked, which prevented complete decompression of esophagus. Expanded neoesophagus caused a mass effect irritating the right atrium and causing atrial fibrillation, while stretching of nociceptive rich mediastinal structures led to persistent severe pain. NGT was manipulated, in an attempt to resolve the kink and although the kink could not be removed completely, it smoothened out enough to deflate the expanded neoesophagus. The pain subsided within 45 min of the NGT manipulation. Electrocardiography pattern also reverted to sinus rhythm within 24 h.

Keywords: Hemodynamic compromise, Esophagectomy, Kinked Nasogastric tube, Mediastinal pain

References

1. Allum WH, Bonavina L, Cassivi SD, Cuesta MA, Dong ZM, Felix VN, et al. Surgical treatments for esophageal cancers. Ann N Y Acad Sci 2014;1325:242-68.
2. Zhao Y, Guo J, You B, Hou S, Hu B, Li H, et al. The dynamic of nasogastric decompression after esophagectomy and its predictive value of postoperative complications. J Thorac Dis 2016;8:S99-106.
3. Raymond D. Complications of esophagectomy. Surg Clin North Am
   2012;92:1299-313.
4. Kim TJ, Lee KH, Kim YH, Sung SW, Jheon S, Cho SK, et al. Postoperative imaging of esophageal cancer: What chest radiologists need to know. Radiographics 2007;27:409-29.
5. Herbella FA, Zamuner M, Patti MG. Esophagectomy perianesthetic care from a surgeon´s point of view. SOJ Anesthesiol Pain Manag 2014;1:1-7.

(Abstract)      (Full Text HTML)      (Download PDF)

.