Aspiration, the inadvertent introduction of fluids or solids into the trachea, is a severe risk in patients with achalasia, presenting major challenges for anesthesia providers. Achalasia is an autoimmune reaction resulting in decreased lower esophageal peristalsis and the inability of the lower esophageal sphincter to relax, preventing the passage of food and liquids. A 47-yearold woman with a history of achalasia presented to the endoscopy suite for esophagogastroduodenoscopy. The patient was admitted with complaints of dysphagia and the inability to tolerate solids and liquids. Despite the recommendation from the gastroenterology team for monitored anesthesia care, the anesthesia care team advocated for general anesthesia with rapid sequence induction to protect the airway. On introduction of the video laryngoscope (GlideScope, Verathon Inc), a pool of saliva and food particles were observed in the posterior oropharynx. This case study examines a severe case of achalasia requiring unconventional treatment. This case illustrates the need for maintaining a high index of suspicion for aspiration risk in patients with achalasia during their precarious and stressful course of management, and the importance of collaboration between the anesthesia and the gastroenterology care teams in safely managing these patients.

Abner Perez

AANA journal

Founded in 1931 and located in Park Ridge, Ill., the AANA is the professional organization for more than 90 percent of the nation’s nurse anesthetists. As advanced practice nurses, CRNAs administer approximately 32 million anesthetics in the United States each year. CRNAs practice in every setting where anesthesia is available and are the sole anesthesia providers in more than two-thirds of all rural hospitals. They administer every type of anesthetic, and provide care for every type of surgery or procedure, from open heart to cataract to pain management.

Founded in 1931 and located in Park Ridge, Illinois, the AANA Journal is the professional organization for over 90% of the nation's nurse anesthetists. As advanced practice nurses, Certified Registered Nurse Anesthetists (CRNAs) administer approximately 32 million anesthetics in the United States each year. CRNAs work in every setting where anesthesia is available and are the sole anesthesia providers in more than two-thirds of all rural hospitals. They administer every type of anesthetic and provide care for a wide range of surgeries and procedures, from open-heart surgery to cataract surgery to pain management.

AANA Journal成立于1931年，位于伊利诺伊州的公园岭，是美国超过90%的护士麻醉师的专业组织。作为高级执业护士，注册护士麻醉师（CRNA）每年在美国施行约3200万例麻醉。CRNA在所有提供麻醉的环境中工作，并且在超过三分之二的乡村医院中是唯一的麻醉提供者。他们能够施行各种类型的麻醉，并为各种手术或程序提供护理，从心脏手术到白内障手术，再到疼痛管理。

Anesthesia Considerations for Patients With Severe Achalasia.

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