An audit of anesthetic management and complications of tracheo-esophageal fistula and esophageal atresia repair

Knottenbelt, Graham, Costi, David, Stephens, Philip, Beringer, Richard and Davidson, Andrew (2012) An audit of anesthetic management and complications of tracheo-esophageal fistula and esophageal atresia repair. Pediatric Anesthesia, 22 3: 268-274. doi:10.1111/j.1460-9592.2011.03738.x

Author Knottenbelt, Graham
Costi, David
Stephens, Philip
Beringer, Richard
Davidson, Andrew
Title An audit of anesthetic management and complications of tracheo-esophageal fistula and esophageal atresia repair
Journal name Pediatric Anesthesia   Check publisher's open access policy
ISSN 1155-5645
Publication date 2012-03
Year available 2011
Sub-type Article (original research)
DOI 10.1111/j.1460-9592.2011.03738.x
Volume 22
Issue 3
Start page 268
End page 274
Total pages 7
Place of publication Oxford, United Kingdom
Publisher Wiley-Blackwell Publishing
Collection year 2012
Language eng
Formatted abstract
Background: Many different anesthetic techniques have been suggested for the management of tracheo-oesophageal fistula/oesophageal atresia (TOF/OA) although the incidence of ventilation difficulty is not well known and it is unclear which technique is best in managing this. The aim of our audit was to determine the incidence of ventilation difficulty during repair of TOF/OA. We also recorded the current practice for anesthesia and analgesia in these children as well as the incidence of comorbidities and surgical complications.
Methods: We retrospectively audited cases of TOF/OA repair over a 3-year period in four hospitals, recording demographics, comorbidities, surgical data, postoperative complications, and anesthetic technique, including ventilation difficulty and management strategy.
Results: A total of 111 patients were identified with TOF/OA, and 106 patient notes and 101 anesthetic records were found. 42% of patients were premature, and 57.5% had significant comorbidities. Death was most likely in infants with low birth weight and low gestational age at birth and in those with major cardiac comorbidity. A range of techniques were used for induction, maintenance, extubation, and pain control. There were ventilation difficulties recorded at induction in seven patients, and significant desaturations were recorded in 15 patients intraoperatively.
Conclusions: This audit adds to the data already published about incidences of complications and comorbidities associated with TOF/OA repair. Defining anesthetic practice with regard to ventilation and analgesic strategies is important in comparing the adequacy and risk of techniques used. Our audit shows that a range of differing anesthetic techniques are still employed by different anesthetists and institutions and details some of the techniques being used for managing difficult ventilation.
Keyword Tracheo-esophageal fistula
Esophageal atresia
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status Non-UQ
Additional Notes Article first published online: 21 NOV 2011

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
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