Lesson 1

Esophageal Atresia & Tracheoesophageal Fistula

  • Definition: Esophageal atresia is the most common congenital defect of the esophagus, often associated with tracheoesophageal fistula (TEF).

  • Diagnosis:

    • Maternal polyhydramnios indicates TEF.

    • Diagnosis confirmed by the inability to pass a gastric tube into the stomach.

    • Symptoms include choking, coughing, and cyanosis during feeding.

  • Type of TEF:

    • Type C is the most common (~90%).

    • Configuration: Upper esophagus ends in a blind pouch; lower esophagus connects to distal trachea.

  • VACTERL Association:

    • 50-70% of TEF patients have other congenital anomalies:

    • Vertebral defects

    • Imperforated anus

    • Cardiac anomalies (e.g., ASD, VSD, tetralogy of Fallot)

    • Renal dysplasia

    • Limb anomalies

  • Anesthetic Considerations:

    • Position: Head up to minimize gastric aspiration risk.

    • Management:

    • Frequent suctioning.

    • Maintain spontaneous ventilation; avoid positive-pressure ventilation to prevent gastric distension.

    • G-tube placement for gastric decompression.

    • Endotracheal tube (ETT) placement: Below the fistula and above the carina to prevent complications.

    • Monitor with a precordial stethoscope to detect right mainstem intubation.

    • Be aware of potential right lung compression during surgical repair, leading to rapid desaturation.