Anaesthetic and surgical airway management during tracheo-oesophageal fistula repair.

A retrospective review of 61 cases of airway management for newborn tracheo-oesophageal fistula (TOF)/oesophageal atresia repair is presented. Standard management included induction of general anaesthesia and muscle relaxation before tracheal intubation, rigid bronchoscopy, careful placement of the tracheal tube below the TOF if possible, and occlusion of the fistula with a Fogarty embolectomy catheter in certain high risk cases. Gastrostomy was not routinely performed. Ventilation proceeded without difficulty in 48 cases. Ventilation difficulties were encountered in 13 cases. Eight of the 13 cases had large TOF, and four had other causes of difficult ventilation not related to the fistula. No patient with a small TOF had ventilation problems because of the TOF. Three patients had a large TOF successfully occluded with an embolectomy catheter through the bronchoscope. There were no complications ascribed to this technique. An algorithm is suggested for anaesthetic-surgical airway management in these cases.