Case Report on Tracheo - Oesophageal Fistula in a New Born - An Anaesthetist's Challenge

Introduction: A fistula is an abnormal connection between 2 epithelial surfaces. A tracheo - oesophageal fistula is the connection between oesophagus and trachea which are normally separate structures. The fistula is a congenital defect and occurs in 1 in 5000 births. Here we report a 1day old preterm male child weighs 1.8 kgs with a Tracheoesophageal fistula who was taken up for surgery under general anaesthesia at our hospital who presented to us with hypoxia and tachypnea during breast feeding. Clinical findings were heart rate 146/min, RR 50/min SpO2 on air was 99%. X - ray chest and abdomen showed coiling of nasogastric tube (NGT) in upper part of esophagus and large gas shadow of stomach. Posted for thoracotomy and tracheoesophageal repair. Methods: Baby was premedicated in the preoperative area and inside the operation room all necessary monitors attached. Baby was induced under general anaesthesia, intubated and maintained on inhalational anaesthetics. Surgery was performed through right thoracotomy in the 4th intercostal space. The TEF was exposed, ligated and end to end anastomosis of the esophagus was done after mobilization. Baby was shifted to NICU intubated for further management and ventilatory support. The baby was discharged on 12th postoperative day. Conclusion: Goals in the anaesthetic management of Tracheoesophageal fistula are many like consideration of poor organ development/ prematurity, difficult airway, negotiation of endotracheal tube beyond the fistula, cardiorespiratory compromise, maintenance of oxygen saturation with adequate depth of anaesthesia, perioperative analgesia and postoperative intensive care.