Anesthesia Management in Neonates with Esophageal Atresia

ZAYED, ELSHURAFA MUEEN (2018) Anesthesia Management in Neonates with Esophageal Atresia. Masters thesis, Universitas Sebelas Maret.

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    Tracheoesophageal fistula (TEF) and esophageal atresia (EA) are defects that may present as part of the VACTERL syndrom. TEF/EA patients require careful attention to airway management and ventilation with the goal of prevention of aspiration. There are several types of tracheoesophageal fistula (TEF); the most common is an upper esophagus that ends in a blind pouch and a lower esophagus that connects to the trachea. Breathing results in gastric distention, and feeding leads to chok-ing, coughing, and cyanosis (the three Cs). TEF is suspected by failure to pass a catheter into the stomach and confirmed by the catheter coiled in a blind, upper esophageal pouch. Aspiration pneumonia and other congenital anomalies (e.g., cardiac) are common, including vertebral defects, anal atresia, TEF with esophageal atresia, and radial dysplasia. • Preoperative management includes identifying congenital anomalies and preventing aspiration pneumonia by nursing in a head-up position, using an oral-esophageal tube, and avoiding feedings. • Sometimes a gastrostomy is placed under local anesthesia. Surgical treatment is usually postponed until any pneumonia clears or improves with antibiotic therapy. • Copious pharyngeal secretions are common and require frequent suctioning. Suctioning of the gastrostomy tube and upper esophageal pouch tube helps prevent aspiration. However, postoperative suctioning of the esophagus may disrupt the surgical repair. • PPV is avoided before intubation because gastric distention may interfere with lung expansion. Intubation is often done awake and without muscle relaxants. • Correct ETT position is crucial. Ideally, the tip of the tube lies between the fistula and the carina. This is impossible if the fistula connects to the carina or a mainstem bronchus; venting using an in situ gastrostomy tube may permit PPV without gastric distention. • Surgical retraction can compress the contralateral lung, great vessels, trachea, heart, and vagus nerve. A drop in O2 satu-ration may indicate that the retracted lung needs to be reexpanded. BP should be monitored with an arterial line. 100% O2 is usually required, and blood should be available. A wide variety of congenital anomalies arise from the organs of the foregut, each associated with unique management principles. The foregut derivatives include the pharynx and its derivatives, the lower respiratory system, the esophagus and stomach, the duodenum, the liver, biliary apparatus, and pancreas (1). While many children with anomalies of the foregut have isolated malformations, it is also possible for these problems too ccur in association with other anomalies or as part of a syndrome that may impact anesthetic management.

    Item Type: Thesis (Masters)
    Subjects: R Medicine > RC Internal medicine
    Divisions: Fakultas Kedokteran
    Fakultas Kedokteran > Spesialis Anestesiologi dan Reaminasi
    Depositing User: Aren Dwipa
    Date Deposited: 04 Dec 2018 18:56
    Last Modified: 04 Dec 2018 18:56

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