Update on anesthetic management for esophagectomy.

PURPOSE OF REVIEW: The article highlights the current important issues surrounding the anesthetic care of patients presenting for esophagectomy.

RECENT FINDINGS: With the decline in mortality from esophagectomy in high-volume centers over the last 30 years, focus may now be on decreasing morbidity. Improving the blood supply of the esophageal anastomosis, methods to reduce the incidence of pulmonary complications and optimizing fluid management in these patients are areas in which anesthetic care may contribute. There are also the potential benefits of minimally invasive techniques, which are increasingly being utilized.

SUMMARY: The incorporation of thoracic epidural analgesia, goal-directed fluid management therapy, protective ventilation during one-lung anesthesia and strategies to improve perfusion of the gastric graft are some aspects which anesthetic care may impact.