Tracheoesophageal Fistula

Question 1

TEF is associated with what conditions?

Answer 1

VACTERL 
Vertebral/vascular anomalies 
Anal atresia 
Cardiac (ASD, VSD) 
TEF
Radial/renal 
Limb deformities

Question 2

What kind of things would you see in a mom with a baby with TEF?

Answer 2

Polyhydramnios, prominent esophageal pouch, small or absent stomach bubble with fluid filled loops of bowel

Question 3

3 Cs associated with TEF?

Answer 3

Coughing, choking, cyanosis

Question 4

In TEF, CXR would reveal:

Gas in the stomach and intestine indicates the present of:

Answer 4

tip of catheter in superior mediastinum

GAs in stomach indicates distal fistula

Question 5

Before going to the OR with TEF patients, what do you want to see/know?

Answer 5

Radiographs of chest, abdomen, pelvis, spine
US of spine and kidney
Echocardiography of the heart and aorta
Also-vascular access and type and cross

Question 6

Goal of pre-op anesthetic management in TEF

Answer 6

Avoid feeding
elevation of head of bed
placement of suction catheter in proximal pouch

Question 7

Induction/inutbation in TEF patients:

What do you want to avoid?

Answer 7

Modified rapid vs awake-awake benefit is patient could have undiagnosed airway issues,
you want to try to avoid positive pressure in an attempt to prevent gastric distention secondary to gases passing through fistula in stomach

Question 8

After intubating, what do you want to listen to and why? ETT and how you’ll tape it?

Answer 8

Listen to stomach and chest to ensure that lungs are adequately ventilated and that stomach is not distended. Typically, ETT is placed in mainstem bronchus and slowsly withdrawn until breath sounds are bilateral.

Question 9

Post-op mgmt for TEF:

Answer 9

Patients are not extubated for up to 5 post op days. Avoid bag masking due to fragility of anastamosis

Question 10

Long term complications of TEF:

Answer 10

GERD
Esophageal stricture
respiratory infections
dysphagia