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Chapter-14 Congenital Tracheoesophageal Fistula: Anesthetic Considerations and Management

BOOK TITLE: Yearbook of Anesthesiology-7

Author
1. Mohta Medha
2. Ahuja Sharmila
ISBN
9789352702978
DOI
10.5005/jp/books/14141_15
Edition
1/e
Publishing Year
2018
Pages
9
Author Affiliations
1. University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, medhamohta@hotmail.com, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India, University College of Medical Sciences and GTB Hospital New Delhi, India, medhamohta@gmail.com, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
2. University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India, University College of Medical Sciences and GTB Hospital New Delhi, India, sharmilaahuja@gmail.com
Chapter keywords
Tracheoesophageal fistula, TEF, esophageal atresia, EA, embryology, anesthetic management, intraoperative management, pain management, wound infection, airway management

Abstract

Congenital tracheoesophageal fistula (TEF) has an incidence of 1 in 2500–3000 live births. It manifests within few hours to days after birth. There are five types of TEF, esophageal atresia with distal tracheoesophageal fistula being the commonest (86%). Common congenital anomalies associated with TEF include vertebral, anorectal, cardiac, renal and limb (VACTERL) malformations. TEF typically presents with symptoms of excessive salivation and repeated episodes of coughing, gagging, choking, regurgitation and cyanosis while feeding. Accurate diagnosis, identification of associated congenital anomalies and optimizing the general condition of the neonate are cornerstones of anesthesia management that influences outcome. This requires correction of fluid-electrolyte and acid-base abnormalities and optimization of chest condition by antibiotics and regular suction of upper esophageal pouch and oropharynx. Complications include anastomotic leak, esophageal stricture, tracheomalacia, repeated chest infections and gastroesophageal reflux. Other long-term sequelae include chronic pain, obstructive and restrictive ventilatory defects and hyper-reactive airway.

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