Anesthetic management of patients undergoing one-step surgical tracheoesophageal fistula: Case series

The anesthetic management of newborns with tracheoesophageal fistula (TEF) and esophageal atresia (EA) can be challenging due to fistula between the airway and esophagus leading to difficulty in perioperative airway management. Maintaining the endotracheal tube (ETT) position during surgical manipulation and adequate ventilation without gastric distention complications is crucial. This study presents two cases of full-term and normal-birthweight newborns with Type C TEF/EA. Both of the patients underwent one-step surgical repair without gastrostomy insertion. Instead of using gastrostomy, correct placement of ETT might be checked by physical examination. Induction of anesthesia was done using volatile inhalational agents and fentanyl as analgetic. For intubation facilitation, spontaneous breath and ventilation were maintained to prevent gastric distention. This report showed that good intubation conditions could be achieved with deep volatile agents and without muscle relaxants. Patients were ventilated with an assisted-controlled technique following their spontaneous breath until the defect was ligated. Hemodynamic was maintained stably in both patients during the operation. Full-term babies with normal birthweight and no other congenital anomalies are generally associated with a better prognosis.