Factors Affecting Anaesthetic Management And Early Post-Operative Outcome In Patients With Esophageal Atresia And Tracheo-Esophageal Fistula – A Prospective Study

Abstract

Esophageal atresia (EA), with or without trachea-esophageal fistula, is a fairly common congenital disorder with an incidence of 18000 per year in India. In Western countries, associated congenital anomaly is the main factor which affects the prognosis. But in India the preoperative condition, intraoperative and postoperative condition and socioeconomic status along with congenital anomaly affects the prognosis. 55 neonates after evaluation for congenital anomalies and routine investigation were operated for TEF and were classified on the basis of Age, Sex, Birth weight, Maturity; presence of pneumonitis, and other associated congenital anomalies. Epidural catheter was passed through L3-L4 interspace in 24 patients after giving GA to provide postoperative analgesia. 3ml of 0.0625% bupivacaine was given for introperative and postoperative analgesia. It was noted the best survival was in babies who were operated in the first two days. Infants weighing greater than 2.5 kg showed 76% survival. Both sexes had the similar results. Patients with severe chest infection showed only survival of 16.6%. Infants with epidural showed 100 % survival. 33.33% of neonates survived after postoperative ventilation, and there is 77.50% survival in neonates who did not require postoperative ventilation. 17 cases had reported congenital anomalies, which showed 41.17% survival and 76.31% survival was noted in neonates who don’t have congenital anomalies. Neonates with preoperative saturation >95% had 86.36% survival but neonates with <85% saturation showed only 33.33% survival. We observed that epidural analgesia would provide got postoperative outcome in TEF neonates, by reducing mortality in these infants.