1
|
Krishnan U, Dumont MW, Slater H, Gold BD, Seguy D, Bouin M, Wijnen R, Dall'Oglio L, Costantini M, Koumbourlis AC, Kovesi TA, Rutter MJ, Soma M, Menzies J, Van Malleghem A, Rommel N, Dellenmark-Blom M, Wallace V, Culnane E, Slater G, Gottrand F, Faure C. The International Network on Oesophageal Atresia (INoEA) consensus guidelines on the transition of patients with oesophageal atresia-tracheoesophageal fistula. Nat Rev Gastroenterol Hepatol 2023; 20:735-755. [PMID: 37286639 DOI: 10.1038/s41575-023-00789-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 06/09/2023]
Abstract
Oesophageal atresia-tracheoesophageal fistula (EA-TEF) is a common congenital digestive disease. Patients with EA-TEF face gastrointestinal, surgical, respiratory, otolaryngological, nutritional, psychological and quality of life issues in childhood, adolescence and adulthood. Although consensus guidelines exist for the management of gastrointestinal, nutritional, surgical and respiratory problems in childhood, a systematic approach to the care of these patients in adolescence, during transition to adulthood and in adulthood is currently lacking. The Transition Working Group of the International Network on Oesophageal Atresia (INoEA) was charged with the task of developing uniform evidence-based guidelines for the management of complications through the transition from adolescence into adulthood. Forty-two questions addressing the diagnosis, treatment and prognosis of gastrointestinal, surgical, respiratory, otolaryngological, nutritional, psychological and quality of life complications that patients with EA-TEF face during adolescence and after the transition to adulthood were formulated. A systematic literature search was performed based on which recommendations were made. All recommendations were discussed and finalized during consensus meetings, and the group members voted on each recommendation. Expert opinion was used when no randomized controlled trials were available to support the recommendation. The list of the 42 statements, all based on expert opinion, was voted on and agreed upon.
Collapse
Affiliation(s)
- Usha Krishnan
- Department of Paediatric Gastroenterology, Sydney Children's Hospital, Sydney, New South Wales, Australia.
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Michael W Dumont
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Hayley Slater
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Benjamin D Gold
- Children's Center for Digestive Health Care, GI Care for Kids, LLC, Atlanta, GA, USA
| | - David Seguy
- University of Lille, Reference Centre for Rare Oesophageal Diseases, CHU Lille, Lille, France
- Department of Nutrition, CHU Lille, Lille, France
| | - Mikael Bouin
- University of Montreal, CHUM Research Center (CRCHUM), Montréal, Quebec, Canada
| | - Rene Wijnen
- Department of Paediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Luigi Dall'Oglio
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mario Costantini
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Anastassios C Koumbourlis
- Division of Pulmonary & Sleep Medicine, Children's National Medical Center, Washington, DC, USA
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Thomas A Kovesi
- Deptartment of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- The University of Ottawa, Ottawa, Ontario, Canada
| | - Michael J Rutter
- Division of Paediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Otolaryngology, University of Cincinnati, Cincinnati, OH, USA
| | - Marlene Soma
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Otolaryngology, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Jessica Menzies
- Department of Nutrition and Dietetics, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | | | - Nathalie Rommel
- Department of Gastroenterology, Department of Neurogastroenterology and Motility, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, ExpORL, Deglutology, University of Leuven, Leuven, Belgium
| | - Michaela Dellenmark-Blom
- Department of Paediatric Surgery, The Queen Silvia Children's hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Vuokko Wallace
- Department of Psychology, University of Bath, Bath, UK
- Department of Psychology, University of Eastern Finland, Joensuu, Finland
| | - Evelyn Culnane
- Transition Support Service, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Graham Slater
- EAT Oesophageal Atresia Global Support Groups e.V., Stuttgart, Germany
| | - Frederic Gottrand
- University of Lille, Reference Centre for Rare Oesophageal Diseases, CHU Lille, Lille, France
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Lille, France
- Institute for Translational Research in Inflammation INFINITE, Inserm Faculté de Médecine, Université de Lille, Lille, France
| | - Christophe Faure
- Division of Paediatric Gastroenterology & Oesophagus Development and Engineering Lab, Sainte-Justine Hospital, Montréal, Quebec, Canada
- Université de Montréal, Montréal, Quebec, Canada
| |
Collapse
|
2
|
Yasui A, Hinoki A, Amano H, Shirota C, Tainaka T, Sumida W, Yokota K, Makita S, Okamoto M, Takimoto A, Nakagawa Y, Uchida H. Thoracoscopic posterior tracheopexy during primary esophageal atresia repair ameliorate tracheomalacia in neonates: a single-center retrospective comparative cohort study. BMC Surg 2022; 22:285. [PMID: 35879691 PMCID: PMC9310495 DOI: 10.1186/s12893-022-01738-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Esophageal atresia (EA) is often associated with tracheomalacia (TM). The severity of TM symptoms varies widely, with serious cases requiring prolonged respiratory support and surgical treatment. Although we performed thoracoscopic posterior tracheopexy (TPT) during primary EA repair to prevent or reduce the symptoms of TM, few studies have investigated the safety and effectiveness of TPT during primary EA repair. Therefore, this study aimed to evaluate the safety and efficacy of TPT in neonates. METHODS We retrospectively reviewed the records of all patients diagnosed with TM who underwent primary thoracoscopic EA repair between 2013 and 2020 at the Nagoya University Hospital. Patients were divided into two groups: TPT (TPT group) and without TPT (control group). TPT has been performed in all patients with EA complicated by TM since 2020. We compared patient backgrounds, surgical outcomes, postoperative complications, and treatment efficacy. RESULTS Of the 22 patients reviewed, eight were in the TPT group and 14 were in the control group. There were no statistically significant differences in the surgical outcomes between the groups (operation time: p = 0.31; blood loss: p = 0.83; time to extubation: p = 0.30; time to start enteral feeding: p = 0.19; time to start oral feeding: p = 0.43). Conversion to open thoracotomy was not performed in any case. The median operative time required for posterior tracheopexy was 10 (8-15) min. There were no statistically significant differences in postoperative complications between the groups (chylothorax: p = 0.36; leakage: p = 1.00; stricture: p = 0.53). The respiratory dependence rate 30 days postoperative (2 [25%] vs. 11 [79%], p = 0.03) and the ratio of the lateral and anterior-posterior diameter of the trachea (LAR) were significantly lower in the TPT group (1.83 [1.66-2.78] vs. 3.59 [1.80-7.70], p = 0.01). CONCLUSIONS TPT during primary EA repair for treatment of TM significantly lowered respiratory dependence rate at 30 days postoperative without increasing the risk of postoperative complications. This study suggested that TPT could improve TM associated with EA.
Collapse
Affiliation(s)
- Akihiro Yasui
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Akinari Hinoki
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hizuru Amano
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kazuki Yokota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Masamune Okamoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Aitaro Takimoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yoichi Nakagawa
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| |
Collapse
|
3
|
Hamed DHED, Hussein A, Magdy B, Elseoudi M, Elbarbary MM, Wishahy AMK. Post-operative bronchoscopy findings of esophageal atresia patients, initial phase of single-institute experience. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00169-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Esophageal atresia (EA) is not a rare congenital anomaly. It is usually accompanied by tracheoesophageal fistula (TEF). Respiratory morbidities are experienced in most of the survivors. Although it was believed that these symptoms tend to improve by age, permanent lung damage may continue to adulthood in some patients. We aimed to assess the respiratory tract in the follow-up period as an attempt to correlate possible findings with symptoms experienced which allowed us to pay more attention to the respiratory tract during the upcoming surgical interventions. Prospective observational study was conducted on patients presented to our institute, throughout 2018, with various degrees of refractory respiratory tract involvement, after having had their EA repaired inside or outside our institute. After exclusion of esophageal causes of these manifestations, bronchoscopy was performed to correlate the findings with the symptoms experienced by these patients. The study does not include patients repaired after 2018 as surgical modifications were performed and are still under study.
Results
Fifteen patients presented with various respiratory symptoms. Although recurrent chest infection is the commonest presentation, acute life-threatening events were reported in 5 patients. Blind-ended tracheal diverticulum was the most common finding observed in 80% of patients. About 76% of these patients were found to have tracheomalacia. Moreover, bronchoscopy was able to detect recurrent tracheoesophageal fistula in 4 patients. Vocal cords were affected in 13% of these patients.
Conclusions
Frequent respiratory symptoms in operated patients warrant careful long-term monitoring and appropriate management. Although bronchoscopy is considered a mandatory pre-repair procedure, it is a crucial tool in evaluating the survivors. It is pivotal to pay more attention to the respiratory tract to modify the surgical techniques to overcome these pitfalls.
Collapse
|
4
|
Mullan K, Mallett P, Thompson AJ, O' Donoghue D. Acute life-threatening episodes in an infant post-TOF repair. BMJ Case Rep 2021; 14:e240305. [PMID: 33608342 PMCID: PMC7896567 DOI: 10.1136/bcr-2020-240305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Kathryn Mullan
- Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Peter Mallett
- Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| | | | - Dara O' Donoghue
- Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| |
Collapse
|
5
|
Lejeune S, Le Mee A, Petyt L, Hutt A, Sfeir R, Michaud L, Fayoux P, Deschildre A, Gottrand F, Thumerelle C. Bronchopulmonary and vascular anomalies are frequent in children with oesophageal atresia. Acta Paediatr 2020; 109:1221-1228. [PMID: 31710383 DOI: 10.1111/apa.15086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/23/2019] [Accepted: 11/07/2019] [Indexed: 12/30/2022]
Abstract
AIM Oesophageal atresia is frequently associated with other malformations, and our aim was to use computed tomography (CT) to explore intrathoracic malformations in patients with this condition. METHOD This was retrospective study of children aged 0-16 with oesophageal atresia who were born in 1996-2013 and followed up at the French reference centre for rare oesophageal diseases at the University of Lille. Computed tomography scans were available for 48 of the 234 patients during follow-up visits, and these were reviewed by a thoracic radiologist. RESULTS More than two-thirds of the scans were performed to explore persistent respiratory symptoms. We found that six patients had a pulmonary malformations: four lobar agenesis, one right pulmonary aplasia and one congenital cystic adenomatoid malformation. Computed tomography enabled us to diagnose unexpected thoracic malformations in 16 patients: four lobar agenesis, six arteria lusoria, five persistent left superior vena cava and one partial anomalous pulmonary venous return. It also confirmed the diagnoses of suspected malformations in five patients: one congenital cystic adenomatoid malformation, one pulmonary hypoplasia, two right-sided aortic arches and one communicating bronchopulmonary foregut malformation. CONCLUSION Intrathoracic anomalies were frequently associated with oesophageal atresia, and contrast-enhanced chest CT scans should be performed on patients with persistent respiratory symptoms.
Collapse
Affiliation(s)
- Stephanie Lejeune
- Pediatric Pulmonology and Allergy Department Pole Enfant Jeanne de Flandre Hospital CHU Lille Univ. Lille Lille France
- CRACMO: Centre de Réference des Affections Chroniques et Malformatives de l'œsophage Reference Centre for Rare Oeophageal Diseases CHU Lille LIRIC UMR 995 Univ. Lille Lille France
| | - Armelle Le Mee
- Pediatric Pulmonology and Allergy Department Pole Enfant Jeanne de Flandre Hospital CHU Lille Univ. Lille Lille France
| | - Laurent Petyt
- Department of Paediatric Imaging Hospital Jeanne de Flandre Hospital CHU Lille Univ. Lille Lille France
| | - Antoine Hutt
- Department of Thoracic Imaging Hospital Calmette CHU Lille Univ. Lille Lille France
| | - Rony Sfeir
- CRACMO: Centre de Réference des Affections Chroniques et Malformatives de l'œsophage Reference Centre for Rare Oeophageal Diseases CHU Lille LIRIC UMR 995 Univ. Lille Lille France
| | - Laurent Michaud
- CRACMO: Centre de Réference des Affections Chroniques et Malformatives de l'œsophage Reference Centre for Rare Oeophageal Diseases CHU Lille LIRIC UMR 995 Univ. Lille Lille France
| | - Pierre Fayoux
- CRACMO: Centre de Réference des Affections Chroniques et Malformatives de l'œsophage Reference Centre for Rare Oeophageal Diseases CHU Lille LIRIC UMR 995 Univ. Lille Lille France
| | - Antoine Deschildre
- Pediatric Pulmonology and Allergy Department Pole Enfant Jeanne de Flandre Hospital CHU Lille Univ. Lille Lille France
- CRACMO: Centre de Réference des Affections Chroniques et Malformatives de l'œsophage Reference Centre for Rare Oeophageal Diseases CHU Lille LIRIC UMR 995 Univ. Lille Lille France
| | - Frederic Gottrand
- CRACMO: Centre de Réference des Affections Chroniques et Malformatives de l'œsophage Reference Centre for Rare Oeophageal Diseases CHU Lille LIRIC UMR 995 Univ. Lille Lille France
| | - Caroline Thumerelle
- Pediatric Pulmonology and Allergy Department Pole Enfant Jeanne de Flandre Hospital CHU Lille Univ. Lille Lille France
- CRACMO: Centre de Réference des Affections Chroniques et Malformatives de l'œsophage Reference Centre for Rare Oeophageal Diseases CHU Lille LIRIC UMR 995 Univ. Lille Lille France
| |
Collapse
|
6
|
Chou CS, Soong WJ, Lee YS, Tsao PC, Chen WY, Chen SJ, Liu CS, Jeng MJ. Fiberoptic bronchoesophagoscopy-assisted evaluation and prognostic factor analysis in children with congenital esophageal atresia and tracheoesophageal fistula. J Chin Med Assoc 2020; 83:180-187. [PMID: 31876795 DOI: 10.1097/jcma.0000000000000246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Esophageal atresia (EA) and tracheoesophageal fistula (TEF) are serious congenital anomalies with high morbidity and mortality. Diagnostic and therapeutic fiberoptic endoscopy has been used in children to evaluate and manage trachea-esophageal anomalies. This study aimed to evaluate the prognostic factors and the role of fiberoptic bronchoesophagoscopy (FB) in managing children with EA and TEF. METHODS From 2000 to 2017, hospitalized children with suspected EA and TEF were enrolled in the study. All associated medical records were retrospectively reviewed. Basic characteristics, diagnoses, age of surgical reconstruction, FB findings, associated anomalies, and survival durations were reviewed. Prognostic factors associated with the patients' mortality were analyzed. RESULTS A total of 33 children were enrolled, and 91% of them were type C. The median age at the time of hospitalization was 26 days (range, birth to 9 years), including 20 (61%) low-birth-weight infants and 26 (79 %) referred patients. FB was performed in patients preoperatively (39%) and postoperatively (96.8%). Among them, 28 patients (85%) had associated anomalies, including 17 (52%) cardiac and 23 (70%) airway anomalies. The median age of 31 patients who underwent surgical reconstruction was 3 (range, 0-39) days. Esophageal anastomotic stricture (21/31, 67.7%) was the most common postsurgical complication. Twenty-three patients (74.2%) received postoperative FB-guided interventions, including balloon dilatation, laser therapy, and stent implantation. Among the 9 mortality cases, the median age at death was 270 (range, 4-3246) days. Significant factor associated with mortality was delayed (> 48 h old) or no surgical reconstruction (p = 0.030). CONCLUSION Delayed (>48-hour old) or no surgical reconstruction was significantly related to mortality in children with congenital EA and TEF. Preoperative and postoperative FB evaluations helped to facilitate diagnoses and nonsurgical managements and resolve the patients' tracheoesophageal problems.
Collapse
Affiliation(s)
- Chia-Sui Chou
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Pediatrics, Taipei Veterans General Hospital, Taoyuan branch, Taoyuan, Taiwan, ROC
- Department of Pediatrics, Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wen-Jue Soong
- Department of Pediatrics, Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatric Pulmonology, China Medical University Children's Hospital, Taichung, Taiwan, ROC
| | - Yu-Sheng Lee
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Pediatrics, Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Pei-Chen Tsao
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Pediatrics, Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Wei-Yu Chen
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Pediatrics, Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Szu-Jung Chen
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chin-Su Liu
- Department of Pediatrics, Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Section of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Mei-Jy Jeng
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Pediatrics, Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| |
Collapse
|
7
|
Masaracchia MM, Polaner DM, Prager JD, DeBoer EM, Dewberry LC, Somme S, Wine T, Janosy NR. Pediatric tracheomalacia and the perioperative anesthetic management of thoracoscopic posterior tracheopexy. Paediatr Anaesth 2018; 28:768-773. [PMID: 29962064 DOI: 10.1111/pan.13420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2018] [Indexed: 12/25/2022]
Abstract
Tracheomalacia is a broad term used to describe an abnormally compliant trachea that can lead to exaggerated collapse and obstruction with expiration. We describe the perioperative management of a complex pediatric patient undergoing a posterior tracheopexy which is a relatively new surgical treatment, with a novel surgical approach-thoracoscopy. This procedure has competing surgical and anesthetic needs and presents unique challenges to the physicians involved in caring for these patients. We also review the current literature on pediatric tracheomalacia and examine the newest treatment options to highlight the potential anesthetic challenges and pitfalls associated with management.
Collapse
Affiliation(s)
- Melissa M Masaracchia
- Department of Anesthesiology, Section of Pediatric Anesthesiology, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - David M Polaner
- Department of Anesthesiology, Section of Pediatric Anesthesiology, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Jeremy D Prager
- Department of Otolaryngology, Pediatric Otolaryngology, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Emily M DeBoer
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Lindel C Dewberry
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stig Somme
- Department of Surgery, Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Todd Wine
- Department of Otolaryngology, Pediatric Otolaryngology, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Norah R Janosy
- Department of Anesthesiology, Section of Pediatric Anesthesiology, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| |
Collapse
|