Tefview 2.6 help5/8/2023 ![]() ![]() ketamine 2 mg/kg IV along with sevoflurane 1.5-2% in oxygen on spontaneous ventilation till loss of corneal reflex and immobility achieved. ![]() glycopyrrolate 0.004 mg/kg, midazolam 0.01 mg/kg, ondensetron 0.05 mg/kg, hydrocortisone 5 mg/kg and dexamethasone 0.5 mg/kg. Preoperatively NG aspiration was done with 5ml syringe. Care to prevent hypothermia was taken by wrapping the baby with cotton rolls and silver foils. Precordial stethoscope was fixed in place. In the operating room, after securing an intravenous line with 24G cannula, monitors were attached for SpO2, ECG, temperature, heart rate and urine output. Patient was transferred to the operating room with oxygen hood (5-6 lit/min). Preoperatively adequate hydration achieved with ringer’s lactate solution as 100 ml/kg/24 hours. GA along with caudal epidural catheterization was planned for surgery. After stabilization and preoperative evaluation patient was accepted for surgical repair of TEF under ASA-III risk consent. Preoperatively baby was kept in upright position and managed with NG tube for aspiration of excessive secretions two hourly and vital monitoring. We report a case of TEF in a one day old baby, for surgical repair managed with general anaesthesia combined with caudal epidural analgesia.įigure 1: Preoperative X-ray chest of baby. Preoperative corrective measures for low birth weight, anemia, medical optimization of aspiration pneumonia or congestive cardiac failure is necessary, thus management of the TEF needs multidisciplinary approach involving neonatologist, intensivist, paediatric surgeon as well as anesthesiologist for successful surgical outcome. Preoperative evaluation with X ray chest after passing nasogastric tube (NG), ECG, ECHO, CT Scan, abdominal and lumbar ultrasound for vertebral anomaly, rigid bronchoscopy for evaluation of the anatomy of airway are considered necessary for anesthetic and post operative intensive care planning. The perioperative factors of major concern to the anaesthesiologist are prematurity < 2kg weight, difficult airway of neonate, associated respiratory distress because of repeated aspirations or lung pathologies, congenital heart diseases (CHD) and large defects. However with surgical repair, the rate of survival exceeds 90%, even in infants with a low birth weight. It is considered a surgically correctable anomaly of the gastrointestinal and respiratory system and continues to be a major challenge in neonatal surgery. The commonest defect is esophageal atresia with distal TEF (type C/IIIB as described by Gross &Vogt). Incidence of TEF is 1:3000 to 4500 of live births which is a congenital anomaly of esophagus & trachea that manifests within first few hours to days of life. Keywords: Tracheoesophageal fistula (TEF) General anaesthesia Caudal epidural Ropivacaine Postoperative analgesia There was excellent hemodynamic stability, satisfactory perioperative pain relief and uneventful recovery. Epidural catheter was passed upto T4 through caudal route to facilitate intra and post operative analgesia with ropivacaine. The baby was induced and intubated under O2 +sevoflurane anesthesia and maintained with muscle relaxant atracurium. We report a case of one day old baby for surgical repair of TEF (type IIIB) that was managed successfully with GA along with caudal epidural analgesia. The use of regional anaesthesia (RA) has found to be very safe and effective when combined with general anaesthesia (GA). Smooth induction /maintenance, adequate intra/post operative analgesia and uneventful post-operative recovery are the major objectives to be achieved with the anaesthetic plan. Mostly these babies are premature having physiological immaturity of various organ systems and in association they may be having lung pathologies or other major congenital defects like VATER/VACTERL anomalies. Surgical repair of trachea-esophageal fistula (TEF) is one of the major neonatal emergencies that poses many challenges to the treating neonatologist, intensivist, paediatric anaesthesiologist and the surgeon.
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