Chapters 191-209 Pediatrics Flashcards
Describe the types of TE fistulas.
Type A: no esphogeal communication with the trachea; 2 blind ends
Type B: Communication with the upper part of the esophageal segment to the trachea
Type C: Communication with the the lower part of the esophageal segment to the trachea– accounts for 90% of all TEF
Type D: both upper and lower esophageal segments connecting to the trachea
Type E: No atresia, esophagus is in continuity, but does have abnormal connection to trachea
Type F: Esophageal stenosis without connection to the trachea
How might an infant present that has Type C TEF?
excessive drooling, cyanosis, coughing relieved by suctioning, clinician unable to pass catheter into stomach,
What radiology imaging would you get to confirm suspicion of TEF?
Xray- curled catheter in upper esophageal pouch with air bubble in stomach
What other abnormalites are common with TEF?
prematurity, heart disease, midline defects
What are some considerations for type of ETT to use in intubating a fetus with TEF?
If has Murphey’s eye, make sure it is facing anterior OR cut it off all together
What would be the steps you would use for induction of anesthesia for patient with TEF?
Rapid sequence or awake intubation with inhalation agents; AVOID NO2. Perform R mainstem intubation and then pull back until have B breath sounds. Continue spontaneous breath sounds until fistula has been ligated.
How will you do 1 lung ventilation for thorascopy for TEF repair?
Fogarty catheter into right mainstem bronchus by bronchoscopy will allow for one-lung ventilation OR left side intubation.
What are postoperative complications after TEF repair?
Avoid aggressive suctioning to stay about from anastomosis site.
Most patients will have swallowing problems, 70% have GERD, stricture of esophagus is common
What are the main differences between omphalocele and gastroschisis?
Omphalocele-75% have other congenital defects- often cardiac defects (VSD most common); is midline
Gastroschisis- not midline (usually right), normal umbilical cord, rarely associated with other congenital abnormalities
What is BeckWith-Wiedemann syndrome?
omphalocele, organomegaly, macroglossia and hypoglycemia
Where can omphaloceles be located and what abnormalities are associated with these other locations?
Epigastric- cardiac and lung abnormalities
Hypogastric- exstrophy of the bladder and other GU abnormalities
What are preoperative considerations for patients with omphalocele OR gastroschisis?
Exposed viscera in bag- helps with heat and fluid loss
- monitor and replace electrolytes, glucose and fluid losses
What is your anesthetia induction strategy for omphalocele/gastroschisis?
GETA with controlled ventilation by RSI
What do you want to watch for during omphalocele/gastroschisis surgery?
Elevated abdominal pressures, high peak airway pressures, IVC compression===circulatory stasis in lower extremities
