TE Fistula Flashcards
What are some considerations for TE fistula? What things are you scared can go wrong?
High risk for pulmonary aspiration
Metabolic derangements including dehydration, acidosis, and hypoglycemia
And if it’s a peds patient-standard considerations for pediatric patient
TE Fistula associated with VACTERL constellation:
Vertebral defects Anal atresia Cardiac anomalies TE fistulae, esophageal atresia Renal anomalies Limb defects (syndactyly)
What kind of hx are you expecting to get from these patients?
Respiratory distress with feeding
Inability to pass NG tube
What would you see on physical exam:
Dehydration/hypovolemia
Hypoxemia (SpO2)
Evidence of VACTERL
Which lab tests do you want to obtain?
ABG
EKG
CXR, renal US/ +/- echocardiogram
How can you optimize TEF:
IV fluids for dehydration, glucose (glucose containing fluids?)
Goals in TEF: What are you trying to prevent? Consider what? No \_\_\_ prior to \_\_\_\_ Spontaneous breathing vs non-spontaneous
- Prevent further aspiration
- consider gastrostomy under local to decompress stomach
- No PPV prior to ETT confirmation
- Keep spontaneously breathing if possible
Options for anesthetic plan in TEF:
GA with ETT only
ICU/STepdown bed in TEF:
Yes
Room setup:
Preductal (right arm) for ABGs
Induction:
Intubate awake with judicious topicalization
Maintain spontaneous ventilation
Advance cuffed tube until just endobronchial on right side, then pull back slightly so breath sounds heard on left
Emergence:
Extubate awake
