Pulmonary Aspiration Albeit Rapid Sequence Induction in Achalasia Cardia- Do we have an Infallible Technique?
Dr. S Parthasarathy,
Professor, Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India.
Achalasia cardia is among the conditions that pose a high risk of aspiration during induction of anaesthesia. This report is about a case of a 23-year-old male patient, where regurgitation and pulmonary aspiration occurred in a patient with achalasia cardia despite Rapid Sequence Induction (RSI). The risk of aspiration in conditions that cause stasis in the oesophagus is much higher due to the anaesthetic induced relaxation of the upper oesophageal sphincter and the proximity of the pooled contents to the oropharynx. The lower oesophageal sphincter being pathological in achalasia cardia does not relax. In this article, even though it is a case report of such an incidence, the various techniques that can be adopted to negate the risk have been explored. Preinduction oesophagoscopy and suctioning, video-laryngoscope guided intubation and ultrasound confirmation of Tracheal Tube (TT) position before initiating ventilation can be adopted in addition to head up positioning and RSI as an infallible technique to abolish the aspiration risk in patients with achalasia cardia. The case report is highlighted in the way to focus on describing safe ways of induction of anaesthesia where there is a high risk of aspiration.