Anesthetic Considerations in Newborns with Tracheoesophageal Fistula and Atresia

Abstract

Introduction: Esophageal atresia is a rare congenital malformation consisting in a defect in the development of the foregut into the esophagus and trachea that occurs approximately at the fourth week of gestation.

Objective: To describe the results of the anesthetic performance in a patient with esophageal atresia and tracheoesophageal fistula, as well as the anesthetic considerations for treating this entity.

Case presentation: A full-term female patient, of white skin color, with a birth weight of 2880 g and APGAR 8-9 at one minute of life, diagnosed with esophageal atresia due to respiratory distress at birth, excessive salivation with choking crisis at 6 hours of birth, and impossibility to insert a nasogastric tube confirmed by chest X-ray, was referred to pediatric surgery and the fistula was repaired. The anesthetic considerations to be followed in the management of this case are presented, considering that they are related to anesthetic drugs, volume replacement and mechanical ventilation strategy.

Conclusions: The urgent surgical resolution in newborns with esophageal atresia is important for their survival; to reduce complications, as well as the adverse effects, that patients may present due to the position and type of intervention, a detailed anesthetic performance is essential. Anesthetic management is a challenge because it requires a multimodal approach in the pre-, intra- and postoperative periods; airway safety and effective ventilation are the guidelines to follow in these diseases.