Occult serious congenital heart disease and tracheoesophageal fistula repair: challenges in neonatal anesthesia

Abstract

A 1-day-old neonate presented to the emergency after vaginal delivery with tracheoesophageal fistula (TEF) and hemivertebra. As the neonate was not maintaining saturation, immediate intubation was done in neonatal ICU, and the infant was shifted to operation theater for emergency TEF repair. Basic screening and auscultation was done for any other coexisting congenital anomaly, which did not reveal any obvious cardiac defects. Neonate was hemodynamically stable. Anesthetic management focused on adequate ventilation and avoidance of gastric distension during positive pressure ventilation. TEF can cause several complications including aspiration, reduction in ventilation, and problems from concomitant congenital anomalies, mostly of cardiac origin. Intraoperatively, the patient may develop hypoxia owing to lung retraction and hemodynamic instability from bleeding or hypothermia. Here, we present a case of a newborn who underwent emergency type-C TEF repair, in which patient had multiple episodes of desaturation, which were managed successfully with Jackson Rees circuit ventilation allowing definitive repair of the TEF. Postoperatively, patient could not be weaned off from ventilator and was diagnosed with total anomalous pulmonary venous connection on echocardiography. This could explain the recurrent intraoperative oxygen desaturations.