• Nika Samadzadeh Tabrizi, Alexander D Shapeton, Jamel Ortoleva, Sridhar R Musuku, and Roman Schumann.
• Department of Cardiothoracic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, 44113, USA. samadzn2@ccf.org.
• J Anesth. 2024 Nov 18.

PurposeFollowing esophagectomy, annually several thousand patients in the United States (US) reach a stable post-esophagectomy status. Such patients may require general anesthesia (GA) for elective procedures, but no generally accepted guidelines exist for the induction of GA in post-esophagectomy patients.MethodsA national survey describing a post-esophagectomy patient was emailed to 23,524 attending anesthesiologists who were members of the American Society of Anesthesiologists. The survey included 3 demographic and 12 anesthetic management questions. Responses were further stratified by gender, years in practice and frequency of exposure to the patient population of interest.ResultsA total of 744 (3.2%) respondents completed the survey. The respondent demographic characteristics closely reflected recent US anesthesiology workforce analyses. Endotracheal tube was the preferred method of airway management for 648 (87.1%), 419 (64.7%) used a rapid sequence induction, and 504 (67.7%) elected a reverse Trendelenburg position, with the latter two choices being favored among anesthesiologists with routine (vs. rarely/never) exposure to post-esophagectomy patients (76.6% vs. 58.4%; p < 0.001; and 73.6% vs. 63.9%; p = 0.021, respectively). Across survey participants, induction of GA was highly variable with differential effects of gender, years in practice and exposure frequency to post-esophagectomy patients.ConclusionsUS attending anesthesiologists' approach to induction of GA in a patient with a history of successful esophagectomy was not uniform. The majority of responses reflected a concern for aspiration in such a patient. Considering surgical and non-surgical upper gastrointestinal changes, establishment of practice guidance to optimize perioperative care is an unmet need.© 2024. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.

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