Thoracic epidural anaesthesia for thoracotomy, oesophageal myotomy and cystotomy-capitonnage in an elderly patient wıth achalasia due to scleroderma

SummaryAn 83-year-old man was hospitalised for achalasia unresponsive to pneumatic dilations. Preoperative CT imaging revealed the dilated oesophagus in addition to multiple left lung hydatid cysts. The present case describes the perioperative anaesthetic and anaesthetic management of a patient with achalasia due to scleroderma undergoing continuous thoracic epidural blockade using 10 mL of bupivacaine 0.5% + 50 mcg fentanyl combined with 1.5% sevoflurane in 50% air + 50% oxygen without neuromuscular blockade and without intravenous opioids for left thoracotomy; myotomy and cystotomy-capitonnage for cysts were carried out at the same session. This anesthetic technique provided good intraoperative relaxation followed by an uneventful recovery and eliminated the need for other postoperative analgesics.