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Manpreet singh

Lady Hardinge Medical College and ass. Hospitals

Title: Anaesthetic management of tracheo-oesophageal fisula with pulmonary atresia, pda with single ventricle with tetrology of fallot

Biography

Biography: Manpreet singh

Abstract

Introduction: Esophageal atresia (EA) with or without trachea-esophageal fistula is a common neonatal emergency which may be associated with major life incompatible cardiac abnormalities1. Survival of such neonate depends on stabilization and proper resuscitation followed by postoperative care.

Case Report: We came across a 4 days old male baby, with diagnosis of EA and distal TEF, posted for right thoracotomy with primary repair under GA. On preoperative evaluation baby had respiratory distress, frothing from mouth & was hemodynamically unstable on dopamine with oxygen saturation (Spo2) of 85% on room air. Intraoperatively surgery was uneventful but baby not able to maintain Spo2 even after ligation of fistula. At time of reversal of neuromuscular blockade, he had active movements, was maintaining SpO2 of 88% with 100% O2 & on dopamine. After extubation he maintained SpO2 of 85% on nasal prongs when shifted to PACU. But after 3 hours of surgery, his Spo2 started falling & developed persistent cyanosis, so trachea was intubated with chest tube insertion on right side done suspecting  pneumothorax or hemothorax or pleural effusion which were subsequently ruled out, emergency 2 D echocardiography showed large VSD, pulmonary atresia, PDA, single ventricle with Tetrology of Fallot. He was started on PGE1, Alprostadil & dobutamine because of worsening hemodynamic instability shifted to NICU but was not able to maintain Spo2>75% with mechanical ventilation. His general physical condition deteriorated over next 2 days and died due to respiratory failure and cardiac arrest.

Discussion and Conclusion: EA- TEF is a major congenital anomaly and when it is associated with life incompatible anomalies like single ventricle along with PDA, VSD and Pulmonary atresia, it becomes a night mare and a real challenge to both pediatric surgeon and anaesthesiologis1,4. Success in survival of neonate with EA-TEF is attributed to improved neonatal care, anesthesia and better understanding of neonatal physiology. But unfortunately our institution is not well equipped with emergency cardiac back up which if would have been there, then after successful ligation of trachea-esophageal fistula, our 4 day old neonate could have been saved, who died of respiratory failure and cardiac arrest. 

Keywords- Esophageal atresia, trachea-esophageal fistula, single ventricle, PDA, VSD