Airway Protection during Anesthesia for Esophagogastroduodendoscopy in Patients with Achalasia

Achalasia is a disorder characterized by aperistalsis of the esophageal body and impaired relaxation of the lower esophageal sphincter. Dysphagia and regurgitation of undigested, retained food or accumulated saliva are common presenting symptoms. Recurrent aspiration pneumonia may also occur particularly in older patients [1]. Patients with achalasia are clearly at a high risk for aspiration during general anesthesia. The rapidsequence induction technique with endotracheal intubation and cricoid pressure is, therefore, indicated [2]. This is a report of two patients with achalasia who underwent esophagogastroduodenoscopy (EGD) during general anesthesia which was induced using the rapid-sequence induction technique. The cases illustrate the limitations of the airway protection that this technique offers such high risk patients.