Anesthetic Implications of Zenker??s Diverticulum

Bilateral guided cervical block for Zenker diverticulum excision in a patient with ankylosing spondylitis

“…The most effective means of preventing aspiration is to avoid general anesthesia. Furthermore, it has been postulated that during diffi cult intubation (as in our patient), blind tracheal intubation attempts may perforate the pouch, resulting in mediastinitis [6]. The diffi cult tracheal intubation due to the severe AS and the presence of ZD prompted us to use a bilateral cervical block guided by a nerve stimulator as the fi rst choice of anesthesia.…”

“…The anesthetic implications of ZD have been discussed by Thiagarajah et al [6]. Regurgitation following induction of general anesthesia in a patient with ZD has been reported.…”

“…Furthermore, other methods of airway management such as the use of the Airtraq (Prodol Meditec, Vizcaya, Spain) or airway scope (Pentax-AWS, Pentax, Tokyo, Japan) have been suggested [9,10]. Awake tracheal intubation has been advised for ZD repair [6], and in patients having AS [1], but this option was rejected by our patient. During operation under nerve block, if an emergency state occurs in ventilation, jet ventilation should be available.…”

Anesthesia for Zenker's Diverticulectomy

“…Typically, it reveals a pouch in the proximal posterior esophagus, with a neck usually located slightly above the level of the cricoid ring (Figure 1). Moreover, an endoscopic examination allows for visualization of the pouch albeit, often filled with undigested food; hence, the commonly encountered regurgitation of undigested food as discussed above (4)(5)(6).…”

“…External pressure (4), may be used to empty this pouch preoperatively. However, this may contribute to iatrogenic regurgitation and subsequent aspiration and is of unproven benefit (4). Positioning the patient in head-up tilt at the time of induction of anesthesia (6), has been used to help prevent aspiration as well.…”