Anesthetic management of tracheo-esophageal fistula

Abstract

: The anesthetic management of a neonate diagnosed to have tracheoesophageal fistula (TEF) 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.