A multicenter audit of the use of bronchoscopy during open and thoracoscopic repair of esophageal atresia with tracheoesophageal fistula

A multicenter audit of the use of bronchoscopy during open and thoracoscopic repair of esophageal atresia with tracheoesophageal fistula

Background Esophageal atresia (EA) with tracheoesophageal fistula is usually repaired in the neonatal period. Preferential ventilation through the fistula can lead to gastric distension. Bronchoscopy has a role in defining the site and size of the fistula, and may be carried out by the surgeon or th...

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Bibliographic Details
Published in:Pediatric anesthesia Vol. 29; no. 6; pp. 640 - 647
Main Authors: Ahmad, Nargis S., Dobby, Nadine, Walker, Eleanor, Sogbodjor, L. Amaki, Kelgeri, Nivedita, Pickard, Amelia, Burrows, Thomas D. R., Nicholson, Katy E., Green, Alice, Shepherd, Liz, Thornley, Helen, Wolfe Barry, Juliet A., Parker, Beverley J., Childs, Sophie L., King, Rumiko G., Mele, Sara, Krishnan, Prakash
Format: Journal Article
Language:English
Published: France Wiley Subscription Services, Inc 01-06-2019
Subjects:
anesthesia
bronchoscopy
Bronchoscopy - statistics & numerical data
esophageal atresia
Esophageal Atresia - surgery
Esophagus
Female
Fistula
Humans
Infant
Infant, Newborn
Infant, Premature
Male
newborn
Retrospective Studies
Surgery
thoracoscopy
thoracotomy
tracheoesophageal fistula
Tracheoesophageal Fistula - surgery
Treatment Outcome
Ventilators
thoracoscopy
tracheoesophageal fistula
thoracotomy
newborn
esophageal atresia
anesthesia
bronchoscopy
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Summary:Background Esophageal atresia (EA) with tracheoesophageal fistula is usually repaired in the neonatal period. Preferential ventilation through the fistula can lead to gastric distension. Bronchoscopy has a role in defining the site and size of the fistula, and may be carried out by the surgeon or the anesthetist. The use of bronchoscopy varies across different institutions. Methods This is a multicenter case note review of infants with EA with tracheoesophageal fistula who underwent surgery between January 2010 and December 2015. This retrospective audit aims primarily to document the use of bronchoscopy during open and thoracoscopic repair at a selection of United Kingdom centers. Respiratory complications, that is relating to airway management, the respiratory system, and difficulty with ventilation, at induction and during surgery, are recorded. The range of techniques for anesthesia and analgesia in these centers is noted. Results Bronchoscopy was carried out in 52% of cases. The incidence of respiratory complications was 7% at induction and 21% during surgery. Thoracoscopic repair usually took longer. One center used high‐frequency oscillatory ventilation, on an elective basis during thoracoscopic repair, to facilitate surgical access and address concerns about hypoxemia and hypercarbia. Conclusion The use of bronchoscopy varies considerably between institutions. Infants undergoing tracheoesophageal fistula repair are at risk of perioperative respiratory morbidity. The advent of thoracoscopic repair has introduced further variation.
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ISSN:1155-5645
1460-9592
DOI:10.1111/pan.13621