Chapter: Clinical Cases in Anesthesia : Tracheoesophageal Fistula
What are the preoperative concerns in a patient with TEF?
What are
the preoperative concerns in a patient with TEF?
There is a 30–50% incidence of associated
anomalies in infants with EA and TEF. Particular combinations have been
described, termed VATER or, more recently, VACTERL (Table 68.2).
The approximate incidence of associated
anomalies is shown in Table 68.3.
The management of TEF patients preoperatively
pri-marily involves preventing pulmonary complications until surgery can be
performed:
·
Cessation
of feeding
·
Positioning
of the infant slightly head-up (30°) to mini-mize regurgitation of gastric
contents through the fistula
·
Intermittent
suctioning of the proximal esophageal pouch catheter
Atelectasis from gastric distention and
aspiration from regurgitation are common pulmonary complications.
There is also an increased incidence of
prematurity in patients with TEF, especially in those who have associated
anomalies. All the concerns of the premature patient must also be assessed in
this situation.
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