Background: Boerhaave syndrome is a spontaneous transmural rupture of the esophagus commonly associated with forceful vomiting or increased intraluminal pressure. Rapid mediastinal contamination and sepsis make it a life-threatening emergency requiring timely diagnosis and surgical repair. Anesthetic management poses significant challenges due to aspiration risk, hemodynamic instability, and the need for one-lung ventilation during thoracotomy. Maintaining oxygenation, preventing contamination of the healthy lung, and stabilizing cardiovascular parameters remain central goals.
Case Presentation: A 42-year-old male presented with sudden-onset severe retrosternal chest pain, persistent cough with mucoid expectoration, and hypotension following multiple vomiting episodes. Clinical examination showed tachycardia and diminished air entry over the left hemithorax. CT thorax revealed a left-sided spontaneous esophageal rupture with pneumomediastinum and pleural contamination, confirming Boerhaave syndrome. After resuscitation and initiation of vasopressor infusion, invasive arterial and central venous lines were established. Rapid-sequence induction was performed with thiopentone and atracurium, followed by the placement of a 37F left-sided double-lumen tube to facilitate one-lung ventilation. Pressure-controlled ventilation with low tidal volumes and PEEP was employed to reduce barotrauma and maintain oxygenation. Hemodynamic stability was achieved with titrated noradrenaline and guided fluid therapy throughout emergency thoracotomy and surgical repair. Postoperatively, the airway was converted to a single-lumen tube, and the patient underwent elective ventilatory support in the ICU for 72 hours before successful weaning and extubation. Prompt diagnosis, urgent surgical intervention, lung-protective ventilation strategies, and vigilant hemodynamic optimization are essential for improved survival and favorable outcomes in Boerhaave syndrome.
Keywords: Boerhaave syndrome; Esophageal perforation; Emergency thoracotomy; One-lung ventilation; Aspiration prevention; Hemodynamic stabilization; Perioperative anesthesia
How to cite this article: Jeevitha V, Mudakanagoudar M, Dhorigol MG, Anesthetic Management Of Boerhaave Syndrome: Perioperative Ventilatory And Hemodynamic Concerns – A Case Report. Int J Drug Deliv Technol. 2026;16(4s): 204-209; DOI: 10.25258/ijddt.16.204-209