[Unexpected vomiting during anesthetic induction in a patient with a history of anterosternal esophageal reconstruction].

A 73-year-old woman with spinal canal stenosis was scheduled for a lumbar fenestration surgery. The patient had received esophagectomy for cancer and anterosternal esophageal reconstruction 5 years before. After the supper the day before the operation, the fast situation to the operation was maintained. On entering operating room, oxygenation was performed for the patient with adequate pressing of the gastric tube on the sternum, and rapid anesthetic induction was performed with propofol, remifentanil and rocuronium. During the induction, a significant amount of solid food residues appeared suddenly in the throat pharynx before positive pressure ventilation. Oral suction was done immediately, and tracheal intubation was performed. After the intubation, while the suction tube could not be inserted to the stomach tube, we positioned it at near the anastomosis between esophagus and gastric tube. Metoclopramide was administered intravenously during the surgery. At the postoperative period, no severe complications including aspiration were observed. When anesthetizing the patient with a history of anterosternal esophageal reconstruction, we should mind the possibility of nonavoidable vomiting during the induction. We strongly recommend the strict restriction of eating and drinking and suction tube insertion to remove the food residues from the patient preoperatively.