Anesthesia for Tracheoesophageal Fistula

Abstract

Due to the advancement of prenatal and neonatal intensive care, patients with tracheoesophageal fistula (TEF) present with minimal respiratory distress and good lung compliance. Preoperative gastrostomy is rare and patients usually tolerate general anesthesia with muscle relaxant and gentle ventilation. Rigid bronchoscopy has become the standard procedure in many centers to identify the location and size of the fistula, to characterize airway anatomy and to place a Fogarty balloon catheter. Primary repair of TEF with either open thoracotomy or thoracoscopic surgery results in great outcomes. On the other hand, low birth weight (<1500 g) and associated complex cardiac anomalies are independent predictors of mortality after TEF repair with only a 27% survival rate. Invasive monitoring is indicated in patients with congenital heart disease, prematurity, poor pulmonary compliance, a large fistula, preoperative ventilatory compromised and those undergoing thoracoscopic repair. This chapter reviews multiple aspects of TEF including (1) Classification and clinical features. (2) Preoperative preparation and investigation. (3) Anesthetic management, especially airway management and intraoperative considerations. (4) Postoperative and long term complications. Table 39.1 summarizes the anesthesia plan with reasoning.