2005 Volume 25 Issue 4 Pages 347-351
A 24-year-old woman was scheduled to undergo osteoplasty for facial bone fracture. Rapid anesthesia was induced with thiamylal, and then fentanyl followed by vecuronium to facilitate intubation. It was impossible to easily ventilate the patient manually after the lightwand intubation. The endotracheal tube was removed and found to be occluded in the oropharynx by the gastric contents. After the gastric contents were cleared, an endotracheal tube was intubated successfully using direct-vision laryngoscopy. Continuous peripheral oxygen saturation monitoring was greater than 99% during the surgical procedure. The patient was transferred to the ICU. She recovered without any adverse events such as aspiration pneumonia. She was postoperatively diagnosed as having esophageal achalasia by esophagography. To prevent regurgitation during induction of anesthesia in a patient with preoperatively a undiagnosed esophageal achalasia, it is important that esophageal dilation in chest x-ray as well as symptoms and signs such as dysphagia, regurgitation, chest pain, heartburn and weight loss are carefully assessed preoperatively.
