Oesophageal atresia: Are “long gap” patients at greater anesthetic risk?

Powell, Laura; Frawley, Jacinta; Crameri, Joe; Teague, Warwick J.; Frawley, Geoff

doi:10.1111/pan.13336

Cited by 10 publications

(8 citation statements)

References 31 publications

(65 reference statements)

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“…VACTERL and CHARGE association and chromosomal anomalies were found in similar proportions to previous work . Some patients were under the care of the palliative care team or had reorientation of their care after surgery because of comorbidity.…”

Section: Discussionsupporting

confidence: 80%

“…Knottenbelt et al defined ventilatory difficulty as either specific comments from the record, severe gastric distension or a significant hypoxemia, and found that it was recorded in 6.9% at induction and 14.9% intraoperatively. Powell et al found difficult airway management occurred in 7.1%, difficult intubation in 3.3% and intraoperative ventilation difficulty in 11.8% . Andropolous et al defined ventilation difficulty as significant hypoxemia or hypercarbia, elevated peak inspiratory pressures, or severe gastric distension, and found that 21% had difficulty with ventilation …”

Section: Discussionmentioning

confidence: 99%

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

Ahmad

Dobby

Walker

et al. 2019

Pediatric Anesthesia

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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.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

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

Ahmad

Dobby

Walker

et al. 2019

Pediatric Anesthesia

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“…Any interrelationships between intraoperative events, type of surgical approach—thoracoscopic or open—and (developmental) outcomes have not yet been elucidated. Comorbidities, intraoperative events like duration of surgery, the occurrence of hypercapnia (and its effect on cerebral autoregulation), acidosis, hypertension, postoperative complications (such as recurrence of the TEF, esophageal stricture formation, and gastro‐esophageal reflux) may negatively affect the short‐ and long‐term clinical outcomes . It is also not known what surgical technique is associated with the best outcome …”

Section: Introductionmentioning

confidence: 99%

“…Comorbidities, intraoperative events like duration of surgery, the occurrence of hypercapnia (and its effect on cerebral autoregulation), acidosis, hypertension, postoperative complications (such as recurrence of the TEF, esophageal stricture formation, and gastro-esophageal reflux) may negatively affect the short-and long-term clinical outcomes. [11][12][13][14][15] It is also not known what surgical technique is associated with the best outcome. 12,16 In this paper we describe the perioperative courses of vital parameters and metabolic derangements as well as the short-term outcome in relation to the type of surgical approach in 101 consecutive neonates undergoing esophageal atresia type C repair.…”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13][14][15] It is also not known what surgical technique is associated with the best outcome. 12,16 In this paper we describe the perioperative courses of vital parameters and metabolic derangements as well as the short-term outcome in relation to the type of surgical approach in 101 consecutive neonates undergoing esophageal atresia type C repair.…”

Section: Introductionmentioning

confidence: 99%

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

Hoorn

Costerus

Lau

et al. 2019

Pediatric Anesthesia

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Background The perioperative management of esophageal atresia/tracheo‐esophageal fistula by open or thoracoscopic approach can be complicated by metabolic derangements. Little is known, however, about the severity of derangements of vital and metabolic parameters in the perioperative period. Aim The aim of this study is to describe the perioperative courses of vital and metabolic parameters in 101 consecutive neonates undergoing surgical repair of esophageal atresia type C. Method In a retrospective cohort study, we extracted all data from the electronic anesthetic and medical charts of patients who underwent esophageal atresia type C repair within 30 days of life (2007‐2017). We distinguished three types of surgery: primary open, primary thoracoscopic, and primary thoracoscopic surgery converted to open surgery. Descriptive analysis was applied. Results The charts of 117 patients were reviewed: data of 101 were included. The perioperative anesthetic management was not standardized; various methods and medications were used for anesthesia induction and maintenance. Intraoperative blood gas analysis data of 72 patients were available and showed derangements regardless of type of surgery. The median pH‐value decreased to 7.21 [IQR 7.14‐7.30] and a pH‐value below 7.20 was found in 29 patients; in four cases below 7.0, with the lowest value 6.83. The median PaCO2 reached an upper level of 7.5kPa [IQR 5.8‐9.2]; in 13 cases above 10.0kPa, with a peak value of 25.8kPa. These high PaCO2 levels fluctuated with lowest measured PaCO2 of median 5.6 [IQR 4.5‐6.6], with the lowest value 2.8kPa. The median PaO2 level reached an upper level of 16.9kPa [IQR 11.8‐25.7], in 22 cases above 20.0kPa, with a peak value of 50.0kPa. These high levels fluctuated with lowest measured PaO2 levels of median 8.3kPa [IQR 6.73‐10.5]; the lowest PaO2 value was 4.7 kPa. Conclusion Open and thoracoscopic correction of esophageal atresia were associated with periods of severe metabolic derangements. These events need to be taken into account for the evaluation of esophageal atresia (surgical) care and in evaluations of short‐ and long‐term outcomes.

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