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Laryngology/Broncho-Esophagology

(438) Safety of MAC Sedation for Esophageal Dilation

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Amy E. Jacks, MD

    Assistant Professor
    The University of Oklahoma
    Edmond, Oklahoma, United States

    • Senior Author(s)

  • Apoorva T. Ramaswamy, MD

    Assistant Professor
    Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio - James Cancer Center at Ohio State University Medical Center, Columbus, Ohio
    Columbus, OH, United States

    • Co-Author(s)

  • MS

    Mayuri Srikanth, BS

    Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA

Disclosure(s):
Amy E. Jacks, MD: No relevant relationships to disclose.


Introduction: Upper esophageal stricture resulting in dysphagia can cause diminished quality of life for patients. One of the most common etiologies of esophageal stricture result from post-radiation induced stenosis in head and neck cancer survivors. Many patients, due to their prior surgical and radiation history, are at higher risk of undergoing general anesthesia (GA). The primary aim of this study was to assess the safety and tolerance of esophagoscopy with balloon dilation under monitored anesthesia care (MAC) sedation in the OR.

Methods: A prospective chart review was conducted from November 2022 – January 2023 including patients > 18 years old who underwent flexible esophagoscopy with balloon dilation for treatment of dysphagia. Data of interest collected included demographics, cancer history, radiation history, intraoperative airway adjuncts, difficult airway classification, ASA classification, anesthesia evaluation of mallampati score, mouth opening, thyromental (TM) distance and cervical neck range of motion (ROM).

Results: Of the 27 patients reviewed, the majority were male (55.5%), with 88.9% of patients having a history of head and neck malignancy and prior radiation. 48.1% of patients were classified as difficult airways. Pre-operative anesthesia evaluation demonstrated an average ASA classification of 2.81 with 74% of patients classified as ASA class 3. The average mallampati score was 2.67 with 58.3% of patients with a mallampati score of 3 or 4. Additionally, 26.1% of patients demonstrated a mouth opening < 3 finger breaths, 13.6% had a shortened TM distance and 12.5% of patients had limited neck ROM.
Esophagoscopy with balloon dilation was successfully completed in all subjects, with only 3 laryngectomy patients (11.1%) requiring intubation via stoma and GA. One additional patient required a short period of bag masking for desaturation below 90%.

Conclusions: Our study showed that in a cohort comprised largely of head and neck cancer survivors who are deemed higher risk for GA these patients can be safely treated with esophagoscopy and balloon dilation in the OR with MAC sedation without complication.