Anesthesia for Zenker's Diverticulectomy

Basem Abdelmalak , Ashish Khanna
Departments of General Anaesthesiology and Outcomes Research, Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA., Departments of General Anaesthesiology and Outcomes Research, Surgical ICU & Center for Critical Care, Anesthesiology Institute, Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
J Anesth Perioper Med 2017; 4(1): 17- 22 . Published on Jan 20, 2017 . doi:10.24015/JAPM.2017.0003
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Aim of review: The anatomic location of Zenker's diverticulum comes along with an inherent risk of aspiration at any given stage of surgery. This risk contributes greatly to the challenge in the anesthetic approach to these patients.

Methods: We have reviewed and summarized the available literature on surgical techniques, complications and the anesthetic management for Zenker's diverticulum in the past decades. Where needed, we mentioned practical clinical pearls from the extensive personal experience of the authors, and their colleagues in the field of anesthesia for otolaryngologic surgery. We also used radiologic images, and artist rendered cartoons to illustrate discussed principles.

Recent findings: Zenker's diverticulum is associated with a risk for aspiration. For open surgery under general anesthesia, consider either a smooth expedited induction in a 10-30 degree head up tilt or induction following an awake intubation. Consider not using oral antacid premedication, nor applying cricoid pressure if the neck of the pouch is above the cricoid ring or inserting a nasogastric tube blindly. Regional anesthesia techniques utilizing superficial and deep cervical plexus blockade can be an alternative. They have the advantages of an awake and responsive patient with preserved reflexes. However, they  are considered technically difficult by some, with a variable failure rate and patient acceptability.

Summary: We have discussed the advances in the surgical techniques to treat Zenker's diverticulum. However, unfortunately, the anesthesia literature has not adequately and directly addressed and/or discussed the anesthetic challenges for Zenker's diverticulectomy in the recent years. Thus, the timely significance of this review where we applied modern concepts and understanding to the management of Zenker's diverticulum. It is our hope that this review increase awareness among current and future clinicians to advance care for Zenker's diverticulum patients.


Citation:  Basem Abdelmalak, Ashish Khanna. Anesthesia for Zenker's diverticulectomy. J Anesth Perioper Med 2017; 4: 17-22. doi: 10.24015/JAPM.2017.0003

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