Minimizing risks during surgery:
Anesthesia and surgery in megaesophagus patients:
The endotracheal tube that causes the problem in ME dogs. The tube put down the windpipe is, in fact, a very important precaution, and particularly so for ME dogs, since its purpose is to avoid that regurgitated food gets breathed in and ends up in the lungs. In ME dogs, the endotracheal tube should *always* be used during anesthesia (and is used in all types of anesthesia, also when a gas mask is used) The connection between anesthesia and onset or aggravation of ME is not the tube in the trachea, but the fact that in certain susceptible dogs, under certain conditions, stomach acids can flow into the esophagus when the dogs are anesthetized, and this can cause a bad esophagitis which could aggravate, or in some cases cause ME. This problem can be avoided by taking certain precautions.
When a patient with megaesophagus requires anesthesia there are some precautions which are suggested to minimize reflux of stomach contents into the esophagus, therefore minimizing aspiration pneumonia. Pretreating one half hour before anesthesia induction with Metoclopromide in those dogs who can tolerate it, will encourage the stomach to empty. Elevating the head end of the surgical table, or placing the patient on a slant, so that the head is above the rear end, minimizes reflux of stomach contents into the esophagus. Leaving the endotracheal tube in until the dog is very actively swallowing, to minimize aspiration, is important. Maintaining elevation of the front end of the pet, preferably in a vertical position (body perpendicular to the floor), while recovering from anesthesia allows any fluid that accumulates in the esophagus to “drain” into the stomach. Any fluid build-up in the esophagus can be easily refluxed and precipitate aspiration pneumonia in dogs with megaesophagus.
Some hospitals assign an assistant or technician to keep the pet elevated, others allow the owner to hold the pet as soon as it is extubated. Prevention of regurgitation, at all costs is paramount in these pets.
It may be a consideration to have the owner give liquid carafate for a few days after surgery, just in case of esophagitis secondary to unavoidable reflux.