Airway and Ventilatory Management Options in Congenital Tracheoesophageal Fistula Repair

MANAGEMENT OF AIRWAY and ventilation in tracheoesophageal fistula (TEF) repair is challenging. A thoughtful approach with alternative options readily available as well as an understanding of the merits and pitfalls of each strategy is important. In this review, the authors focus only on important aspects of airway and ventilation management based on the most common type of TEF—esophageal atresia and distal tracheoesophageal fistula (type C)—which accounts for 86% of cases of this congenital anomaly. 1 Spitz L. Oesophageal atresia. Orphanet J Rare Dis. 2007; 2: 24 Crossref PubMed Scopus (335) Google Scholar The VACTERL association (including vertebral defects, anal atresia, cardiac anomalies, TEF, renal agenesis and dysplasia, and limb anomalies), issues related to the newborn and prematurity, and neonatal anesthetic concerns in general, are covered extensively in the literature, and discussion of these is not repeated here. Management of complicated neonates is highly technical. High-level evidence on how best to manage the airway and ventilation in TEF is scarce or nonexistent. It is important to acknowledge that although the authors have incorporated much of the published evidence into the present review, much of the authors' personal experience and probable bias also have been included.