A multicenter audit of the use of bronchoscopy during open and thoracoscopic repair of esophageal atresia with tracheoesophageal fistula

Abstract

Background: Esophageal atresia (EA) with tracheoesophageal fistula is usually repaired in the neonatal period. Preferential ventilation through the fistula can lead to gastric distension. Bronchoscopy has a role in defining the site and size of the fistula, and may be carried out by the surgeon or the anesthetist. The use of bronchoscopy varies across different institutions.Methods: This is a multicenter case note review of infants with EA with tracheoesophageal fistula who underwent surgery between January 2010 and December 2015. This retrospective audit aims primarily to document the use of bronchoscopy during open and thoracoscopic repair at a selection of United Kingdom centers.Respiratory complications, that is relating to airway management, the respiratory system, and difficulty with ventilation, at induction and during surgery, are recorded.The range of techniques for anesthesia and analgesia in these centers is noted.Results: Bronchoscopy was carried out in 52% of cases. The incidence of respiratory complications was 7% at induction and 21% during surgery. Thoracoscopic repair usually took longer. One center used high-frequency oscillatory ventilation, on an elective basis during thoracoscopic repair, to facilitate surgical access and address concerns about hypoxemia and hypercarbia. Conclusion: The use of bronchoscopy varies considerably between institutions.Infants undergoing tracheoesophageal fistula repair are at risk of perioperative respiratory morbidity. The advent of thoracoscopic repair has introduced further variation. K E Y W O R D S anesthesia, bronchoscopy, esophageal atresia, newborn, thoracoscopy, thoracotomy, tracheoesophageal fistula | 641 AHMAD et Al. How to cite this article: Ahmad NS, Dobby N, Walker E, et al. A multicenter audit of the use of bronchoscopy during open and thoracoscopic repair of esophageal atresia with tracheoesophageal fistula. Pediatr Anesth. 2019;29:640-647.

Perioperative management of esophageal atresia/tracheo‐esophageal fistula: An analysis of data of 101 consecutive patients

“…There still is no general consensus on a preferred surgical technique (open vsthoracoscopic procedure) . The medical and surgical management of EA repair are decided in light of comorbidities, type of EA/TEF, experience of the surgeon, distance between the two ends of the esophagus, surgical and anesthesiologist preference and local hospital practice . Therefore, the perioperative anesthetic management of EA/TEF in the Erasmus MC‐Sophia Children's Hospital was not standardized, which caused a wide variation in care.…”

“…The asterisk (*) represents the sole intraoperative capillary blood gas analysis. All other measured blood gas values are from arterial blood gas samples [Colour figure can be viewed at wileyonlinelibrary.com] TEF, experience of the surgeon, distance between the two ends of the esophagus, surgical and anesthesiologist preference and local hospital practice 2,32. Therefore, the perioperative anesthetic management of EA/TEF in the Erasmus MC-Sophia Children's Hospital was not standardized, which caused a wide variation in care.Independent of the surgical technique used, periods of severe intraoperative acidosis, hypercapnia, hypocapnia, hyperoxia, and hypoxemia, mostly independent of hypo-and hypertension, occurred in the patients in this study.…”

Battery swallow‐induced tracheoesophageal fistula in a pediatric patient

“…Risks involved with TEF surgical ligation are associated with fragile necrotic tissue, including fistula formation, tracheal separation, pneumothorax, pneumomediastinum, esophageal stricture, vocal cord paralysis, thyroid hemorrhage, spine spondylodiscitis, bleeding (if aorto-esophageal fistula formed), chest infections/sepsis, and death. 3 Anesthetic management challenges are ETT placement failure if TEF size and position are unknown, postoperative airway obstruction, aspiration, and loss of airway from bleeding or difficulty with ETT replacement. Anesthesia safety precautions for battery swallow-induced TEF rely on understanding size and position of the TEF preoperatively.…”

Battery Swallow-Induced Tracheoesophageal Fistula in a Pediatric Patient

“…Risks involved with TEF surgical ligation are associated with fragile necrotic tissue, including fistula formation, tracheal separation, pneumothorax, pneumomediastinum, esophageal stricture, vocal cord paralysis, thyroid hemorrhage, spine spondylodiscitis, bleeding (if aorto-esophageal fistula formed), chest infections/sepsis, and death. 4 Anesthetic management challenges are endotracheal tube (ETT) placement failure if TEF size and position are unknown, post-operative airway obstruction, aspiration, and loss of airway from bleeding or difficulty with ETT replacement. Anesthesia safety precautions for battery swallow-induced TEF rely on understanding size and position of the TEF pre-operatively.…”