Anesthesiology pp 381-386 | Cite as

Anesthesia for Tracheoesophageal Fistula



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.


Congenital anomaly Esophageal atresia Neonate Neonatal anesthesia Tracheoesophageal fistula 


  1. 1.
    Spitz L. Esophageal atresia. Lessons I have learned in a 40-year experience. J Pediatr Surg. 2006;41(10):1635–40.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Gayle JA, Gomez SL, Baluch A, Fox C, Lock S, Kaye A. Anesthetic considerations for the neonate with tracheoesophageal fistula. Middle East J Anaesthesiol. 2008;19(6):1241–54.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Diaz LK, Akpek EA, Dinavahi R, Andropoulos DB. Tracheoesophageal fistula and associated congenital heart disease: implications for anesthetic management and survival. Paediatr Anaesth. 2005;15(10):862–9.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Okamoto T, Takamizawa S, Arai H, Bitoh Y, Nakao M, Yokoi A, et al. Esophageal atresia: prognostic classification revisited. Surgery. 2009;145(6):675–81.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Broemling N, Campbell F. Anesthetic management of congenital tracheoesophageal fistula. Paediatr Anaesth. 2011;21(11):1092–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Greemberg L, Fisher A, Katz A. Novel use of neonatal cuffed tracheal tube to occlude tracheo-oesophageal fistula. Paediatr Anaesth. 1999;9(4):339–41.CrossRefPubMedGoogle Scholar
  7. 7.
    Baraka A, Akel S, Haroun S, Yazigi A. One-lung ventilation of the newborn with tracheoesophageal fistula. Anesth Analg. 1988;67(2):189–91.CrossRefPubMedGoogle Scholar
  8. 8.
    Andropoulos DB, Rowe RW, Betts JM. Anaesthetic and surgical airway management during tracheo-oesophageal fistula repair. Paediatr Anaesth. 1998;8(4):313–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Kane TD, Atri P, Potoka DA. Triple fistula: management of a double tracheoesophageal fistula with a third H-type proximal fistula. J Pediatr Surg. 2007;42(6):E1–3.CrossRefPubMedGoogle Scholar
  10. 10.
    Krosnar S, Baxter A. Thoracoscopic repair of esophageal atresia with tracheoesophageal fistula: anesthetic and intensive care management of a series of eight neonates. Paediatr Anaesth. 2005;15(7):541–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Ni Y, Yao Y, Liang P. Simple strategy of anesthesia for the neonate with tracheoesophageal fistula: a case report. Int J Clin Exp Med. 2014;7(1):327–8.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Petrosyan M, Estrada J, Hunter C, Woo R, Stein J, Ford HR, et al. Esophageal atresia/tracheoesophageal fistula in very low-birth-weight neonates: improved outcomes with staged repair. J Pediatr Surg. 2009;44(12):2278–81.CrossRefPubMedGoogle Scholar
  13. 13.
    Richter GT, Ryckman F, Brown RL, Rutter MJ. Endoscopic management of recurrent tracheoesophageal fistula. J Pediatr Surg. 2008;43(1):238–45.CrossRefPubMedGoogle Scholar
  14. 14.
    Al-Shanafey S, Harvey J. Long gap esophageal atresia: an Australian experience. J Pediatr Surg. 2008;43(4):597–601.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Anesthesia and PediatricsCincinnati Children’s Hospital Medical CenterCincinnatiUSA

Personalised recommendations