Airway management of tracheoesophageal fistula surgery: 35 cases analysis

Objective A retrospective analysis on 35 cases of tracheoesophageal fistulas (TEFs) by different surgical methods was designed to summarize the anesthesia management and the most critical airway management in these patients. Methods Records of thoracic anesthesia cases were diagnosed as were selected from the Anesthesia Information System from August 2006 to September 2017. Medical records of patients were obtained from Hospital Information System by following the admission number. The contents including surgeries, hospitalization and following-up visit records were analyzed and summarized. Results In the 35 patients, six different procedures and four different ventilation protocols including double-lumen, single-lumen, single-lumen bronchial intubation and rigid bronchoscope for anesthesia management were applied. No anesthetic-related complications were observed. The prognosis of patients are: 21 patients were cured, 10 patients were improved and 4 patients died. Conclusions The key points of airway management in TEFs anesthesia: preoperatively improvement of the general situation of TEFs patients including nutrition status, confirming the position and size of fistula before induction, intubation with clear vision to avoid worse damage, drainage to prevent reflux aspiration and ventilation difficulties. In addition, muscle relaxation is required for using rigid bronchoscope while endotracheal intubation is safe for airway management transition. Also, head flexion after surgery under sedation and analgesia and resuming spontaneous breathing as soon as possible. Key words: Tracheoesophageal fistulas; Anesthesia; Airway management