Tracheoesophageal Fistula Flashcards
TEF is associated with what conditions?
VACTERL Vertebral/vascular anomalies Anal atresia Cardiac (ASD, VSD) TEF Radial/renal Limb deformities
What kind of things would you see in a mom with a baby with TEF?
Polyhydramnios, prominent esophageal pouch, small or absent stomach bubble with fluid filled loops of bowel
3 Cs associated with TEF?
Coughing, choking, cyanosis
In TEF, CXR would reveal:
Gas in the stomach and intestine indicates the present of:
tip of catheter in superior mediastinum
GAs in stomach indicates distal fistula
Before going to the OR with TEF patients, what do you want to see/know?
Radiographs of chest, abdomen, pelvis, spine
US of spine and kidney
Echocardiography of the heart and aorta
Also-vascular access and type and cross
Goal of pre-op anesthetic management in TEF
Avoid feeding
elevation of head of bed
placement of suction catheter in proximal pouch
Induction/inutbation in TEF patients:
What do you want to avoid?
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
After intubating, what do you want to listen to and why? ETT and how you’ll tape it?
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 Typically, ETT is placed in mainstem bronchus and slowsly withdrawn until breath sounds are bilateral.
Post-op mgmt for TEF:
Patients are not extubated for up to 5 post op days. Avoid bag masking due to fragility of anastamosis
Long term complications of TEF:
GERD
Esophageal stricture
respiratory infections
dysphagia