Anesthetic management of tracheo-esophageal fistula

Abstract

The anesthetic management of a neonate diagnosed to have tracheoesophageal fistula with or without esophageal atresia (EA) is challenging, especially due to abnormally connected airway and esophagus interfering with patency of the airway and compromising ventilation. The anatomical variations regarding this congenital anomaly and the associated anomalies in various systems, determines both the surgical intervention and the anesthetic management. An urgent surgical intervention may be required within the first 48 hours after birth in case of severe respiratory compromise. On the other hand, a staged approach may be preferred including a gastrostomy in case of either the presence of low-birth-weight, isolated EA or more critical co-morbidities. A laryngotracheobronchoscopy is often performed prior to definitive surgery in order to identify the location and size of fistula, as well as, secondary upper airway anomalies. In the preoperative period, airway must be secured, and optimizing the status of the neonate in terms of other system functions should have a high priority. Intraoperatively, regardless of the agents used, the anesthetic management should focus on adequate depth of anesthesia, and adequate ventilation and oxygenation. The coordination between the anesthetist and the surgeon is crucial during the surgery in order to secure adequate ventilation and oxygenation. The associated anomalies should be considered as the main determinants of perioperative mortality and morbidity, hence, anesthetic management should also focus on intraoperative maintenance of preoperatively optimized functions. The analgesic management in the postoperative period is often provided by multimodal analgesic use.

Anesthesia Management in A Newborn Baby with Tracheoesophageal Fistula: A Case Report

“…Because reintubation is not a desirable intervention, the timing of tracheal extubation should be decided by a team of anesthetists, surgeons, and neonatologists/intensivists. 16 In this patient, postoperative care was carried out in the neonatal intensive care unit (NICU) on a ventilator for 12 days without complications. Then the patient was treated in the usual room and sent home.…”

Routine Fogarty Catheter Occlusion of Fistula in Esophageal Atresia with Tracheoesophageal Fistula Surgery: A Retrospective Study

“…1 Congenital EA with a distal tracheoesophageal fistula (EA/TEF), or Gross type C, is the most common type, comprising 85% of EA cases. 2 This congenital anomaly is often associated with the anomalies described by the acronym VACTERL (vertebral anomalies, imperforated anus, congenital heart disease (CHD), tracheoesophageal anomalies, renal anomalies and limb anomalies). Surgical repair and anesthetic management are challenging because of the difficulty in management of airway and ventilation, control of adverse hemodynamic from associated anomalies of cardiovascular system and the thoracotomy procedure.…”

“…Surgical repair and anesthetic management are challenging because of the difficulty in management of airway and ventilation, control of adverse hemodynamic from associated anomalies of cardiovascular system and the thoracotomy procedure. [2][3][4] Original Article SMJ…”

“…Use of a Fogarty catheter to occlude the fistula, by using rigid or flexible bronchoscopy, can be used to improved lung function and their medical condition. 2,5 The classic technique for airway and ventilation management for TEF repair is to maintain spontaneous ventilation and pass the endotracheal tube (ET) tip distal to fistula. 6 Despite this technique, ineffective ventilation may occur because of inadvertent placement of the ET in the fistula, unintentional ventilation of the fistula, or massive gastric distention.…”