MedEdPORTAL (Dec 2015)
Anesthetic Management of Tracheoesophageal Fistula in a Premature Newborn With Hypoplastic Left Heart Syndrome
Abstract
Abstract Tracheoesophageal fistula (TEF), hypoplastic left heart syndrome (HLHS), and anesthetic implications of prematurity are commonly tested topics for all anesthesiology trainees seeking board certification. Advanced residents and pediatric anesthesiology fellows may participate in or even direct the complex management of a neonate with all three concomitant problems. This resource was created for pediatric anesthesiologists and pediatric anesthesiology fellows but could also be useful for advanced anesthesiology residents during the pediatric anesthesiology rotation, as well as for pediatric surgical fellows. The aim of this case-based exercise is to develop cognitive skills required of consultant anesthesiologists: understanding complex physiology, understanding the interactions of physiology and the surgical procedure, and prioritizing seemingly irreconcilable competing goals. The resource takes approximately 60-90 minutes, with participants arriving having read the provided case description. A case discussion file is provided to aid a moderator in guiding the case discussion. This resource was deployed at the Society for Pediatric Anesthesiology (SPA) Winter Meeting in Tampa, Florida in February 2012, and the SPA Winter Meeting in Las Vegas, Nevada, in March 2013. During both of these presentations, the participants were well versed on the various subtypes of tracheoesophageal fistula and the ramifications of unrepaired single ventricle physiology. Most participants were also knowledgeable regarding various surgical options and intraoperative considerations for repair of tracheoesophageal fistula. Thus, the majority of the exercise was focused on three primary points, which were enthusiastically discussed and argued. These points included: (a) the interplay of cardiac and pulmonary physiology when presented with a neonate with single ventricle physiology and tracheoesophageal fistula undergoing a thoracotomy, (b) stratification of anesthetic risk and preoperative management that could lessen risk, and (c) how to strategize management of intraoperative pulmonary and cardiovascular crises that might arise in such a patient.
Keywords
