ABSTRACT: Anaesthesia for a case of achalasia cardia with abnormal pulmonary function tests posted for heller’scardiomyotomy

Introduction: Achalasia cardia is a disorder of the esophagus which affects the ability of the esophagus to move food into stomach due to failure of lower esophageal sphincter relaxation. The major anesthetic consideration for patients with esophageal disease is the risk of pulmonary aspiration.

Case report: A 45year old male patient presented with achalasia cardia with signs of aspiration pneumonia posted for heller’scardiomyotomy. Pulmonary function tests were poor showing signs of obstructive airway disease. Pulmonologist said patient is unfit for surgery under general anaesthesia due to poor pulmonary function tests. This case describes anaesthetic management with high lumbar epidural blockade (L1 - L2) with injection Lignocaine 2% + adrenaline without affecting respiratory functions with smooth anaesthesia course.

Conclusion: High lumbar epidural preserved lung functions with stable intra operative hemodynamics and also provided good post operative analgesia and smooth recovery.