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.