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Li M, Zhuang L, Hu S, Sun L, Liu Y, Dou Z, Jiang T. Intelligent diagnosis of lung nodule images based on machine learning in the context of lung teaching. Medicine (Baltimore) 2024; 103:e37266. [PMID: 38457590 PMCID: PMC10919509 DOI: 10.1097/md.0000000000037266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 01/21/2024] [Accepted: 01/24/2024] [Indexed: 03/10/2024] Open
Abstract
The vast majority of intelligent diagnosis models have widespread problems, which seriously affect the medical staff judgment of patients' injuries. So depending on the situation, you need to use different algorithms, The study suggests a model for intelligent diagnosis of lung nodule images based on machine learning, and a support vector machine-based machine learning algorithm is selected. In order to improve the diagnostic accuracy of intelligent diagnosis of lung nodule images as well as the diagnostic model of lung nodule images. The objectives are broken down into algorithm determination and model construction, and the proposed optimized model is solved using machine learning techniques in order to achieve the original algorithm selected for intelligent diagnosis of lung nodule photos. The validation findings demonstrated that dimensionality reduction of the features produced 17 × 1120 and 17 × 2980 non-node matrices with 1216 nodes and 3407 non-nodes in 17 features. The support vector machine classification method has more benefits in terms of accuracy, sensitivity, and specificity when compared to other classification methods. Since there were some anomalies among both benign and malignant tumors and no discernible difference between them, the distribution of median values revealed that the data was symmetrical in terms of texture and gray scale. Non-small nodules can be identified from benign nodules, but more training is needed to separate them from the other 2 types. Pulmonary nodules are a common disease. MN are distinct from the other 2 types, non-small nodules and benign small nodules, which require further training to differentiate. This has great practical value in teaching practice. Therefore, building a machine learning-based intelligent diagnostic model for pulmonary nodules is of significant importance in helping to solve medical imaging diagnostic problems.
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Affiliation(s)
- Miaomiao Li
- Department of Respiratory and Critical Care Medicine, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, People’s Republic of China
| | - Lilei Zhuang
- Department of Gastroenterology, Yiwu Central Hospital, Yiwu, Zhejiang, People’s Republic of China
| | - Sheng Hu
- Department of Radiology, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, People’s Republic of China
| | - Li Sun
- Department of Respiratory and Critical Care Medicine, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, People’s Republic of China
| | - Yangxiang Liu
- Department of Respiratory and Critical Care Medicine, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, People’s Republic of China
| | - Zhengwei Dou
- Department of Respiratory and Critical Care Medicine, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, People’s Republic of China
| | - Tao Jiang
- Department of Respiratory and Critical Care Medicine, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, People’s Republic of China
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Kano M, Sugiyama D, Ueda K, Kobayashi O. Anesthetic management of a patient with trisomy 18 undergoing esophageal banding and preceding gastrostomy-A case report. Clin Case Rep 2022; 10:e6404. [PMID: 36225624 PMCID: PMC9529609 DOI: 10.1002/ccr3.6404] [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: 05/18/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 11/04/2022] Open
Abstract
A patient diagnosed with trisomy 18 is at great risk of perioperative morbidity and mortality, especially with complex congenital cardiac anomalies. Here, we report successful anesthetic management of palliative esophageal-banding and gastrostomy for trachea-esophageal fistula in a patient who had a complex congenital heart disease with trisomy 18.
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Affiliation(s)
- Misaki Kano
- Department of AnesthesiologyKameda Medical CenterKamogawa CityJapan
| | - Daisuke Sugiyama
- Department of AnesthesiologyKameda Medical CenterKamogawa CityJapan
| | - Kenichi Ueda
- Department of AnesthesiologyKameda Medical CenterKamogawa CityJapan
| | - Osamu Kobayashi
- Department of AnesthesiologyKameda Medical CenterKamogawa CityJapan
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3
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Airway Management of Esophageal Atresia and Tracheoesophageal Fistula Combined with Anal Atresia. Case Rep Anesthesiol 2022; 2022:3775140. [PMID: 36106199 PMCID: PMC9467743 DOI: 10.1155/2022/3775140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/23/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022] Open
Abstract
Esophageal atresia (EA) associated with tracheoesophageal fistula (TEF) is a common congenital airway anomaly and may be associated with other gastrointestinal abnormalities. Neonates with EA/TEF are at high risk of gastrointestinal distension due to the shunting of air via the fistula, leading to progressive diaphragmatic elevation and regurgitation of the gastrointestinal contents. EA/TEF associated with anal atresia in a neonate makes airway management even more challenging particularly when managed for the repair of TEF through thoracotomy. Here, we report a case where we succeeded in conducting the flexible bronchoscopy insertion through a laryngeal mask to block the fistula by bronchial blocker under spontaneous breathing.
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4
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Diez OH, Sidler M, Amrhein P, Rose MA, Alazki A, Bahr M, Loff S. Endoscopic treatment of a tracheal mucosal tunnel after multiple recurrences of a trachea-esophageal fistula. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
PURPOSE Tracheoesophageal fistula (TEF) is a bellwether for a country's ability to care for sick newborns. We aim to review the existing literature from low- and middle-income countries in regard to management of those newborns and the possible approaches to improve their outcomes. METHODS A review of the existing English literature was conducted with the aim of assessing challenges faced by providers in LMIC in terms of diagnostic, preoperative, operative and post-operative care for TEF patients. We also review the limited literature for performing thoracoscopic repair in the developing world context and suggest methods for introduction of advanced thoracoscopic procedures including techniques for providing anesthesia to these challenging babies. RESULTS While outcomes related to technique from LMIC are comparable to the developed world, rates of secondary complications like sepsis and pneumonia are higher. In many areas, repairs are conducted in a staged fashion with minimal utilization of thoracoscopic approach. The paucity of resources creates strain on intraoperative and post-operative management. CONCLUSION Clearly, not all developing world contexts are ready to attempt thoracoscopic repair but we outline suggestions for assessing the existing capabilities and a stepwise gradual implementation of advanced thoracoscopy when appropriate.
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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.
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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
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Ahmad NS, Dobby N, Walker E, Sogbodjor LA, Kelgeri N, Pickard A, Burrows TDR, Nicholson KE, Green A, Shepherd L, Thornley H, Wolfe Barry JA, Parker BJ, Childs SL, King RG, Mele S, Krishnan P. A multicenter audit of the use of bronchoscopy during open and thoracoscopic repair of esophageal atresia with tracheoesophageal fistula. Paediatr Anaesth 2019; 29:640-647. [PMID: 30811748 DOI: 10.1111/pan.13621] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/15/2019] [Accepted: 02/24/2019] [Indexed: 01/06/2023]
Abstract
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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Affiliation(s)
- Nargis S Ahmad
- Department of Anaesthesia, Great Ormond Street NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Nadine Dobby
- Department of Anaesthesia, Great Ormond Street NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Eleanor Walker
- Department of Anaesthesia, Great Ormond Street NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - L Amaki Sogbodjor
- Department of Anaesthesia, Great Ormond Street NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Nivedita Kelgeri
- Jackson Rees Department of Paediatric Anaesthesia, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Amelia Pickard
- Department of Anaesthesia, Bristol Royal Hospital for Children, Bristol, UK
| | - Thomas D R Burrows
- Department of Anaesthesia, Bristol Royal Hospital for Children, Bristol, UK
| | - Katy E Nicholson
- Department of Anaesthesia, Evelina London Children's Hospital, Guy's & St Thomas's Hospital NHS Foundation Trust, London, UK
| | - Alice Green
- Department of Anaesthesia, Evelina London Children's Hospital, Guy's & St Thomas's Hospital NHS Foundation Trust, London, UK
| | - Liz Shepherd
- Department of Anaesthesia, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Helen Thornley
- Department of Anaesthesia, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | | | | | - Sophie L Childs
- Department of Anaesthesia, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Rumiko G King
- Department of Anaesthesia, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sara Mele
- Department of Anaesthesia, Royal Brompton NHS Foundation Trust, London, UK
| | - Prakash Krishnan
- Department of Anaesthesia, Royal Brompton NHS Foundation Trust, London, UK
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Taghavi K, Stringer MD. Preoperative laryngotracheobronchoscopy in infants with esophageal atresia: why is it not routine? Pediatr Surg Int 2018; 34:3-7. [PMID: 29022107 DOI: 10.1007/s00383-017-4194-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2017] [Indexed: 01/28/2023]
Abstract
The value of laryngotracheobronchoscopy (LTB) immediately prior to repair of esophageal atresia with or without tracheo-esophageal fistula is contentious. Currently, there is a wide range of opinion on the utility of this investigation which is reflected by huge variation in clinical practice. This review is a critical analysis of the arguments for and against performing routine LTB prior to esophageal atresia repair. Reserving LTB for selected cases only is potentially disadvantageous since it limits the surgeon's and anesthetist's familiarity with the procedure, equipment, and range of potential findings. There is sufficient evidence to suggest that routine preoperative LTB becomes the standard of care.
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Affiliation(s)
- Kiarash Taghavi
- Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand.,Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Mark D Stringer
- Department of Paediatric Surgery, Wellington Children's Hospital, Riddiford Street, Newtown, Wellington, 6021, New Zealand. .,Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand.
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10
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Abstract
There have been major advances in the surgery for oesophageal atresia (OA) and tracheo-oesophageal fistula(TOF) with survival now exceeding 90%. The standard open approach to OA and distal TOF has been well described and essentially unchanged for the last 60 years. Improved survival in recent decades is most attributable to advances in neonatal anaesthesia and perioperative care. Recent surgical advances include the use of thoracoscopic surgery for the repair of OA/TOF and in some centres isolated OA, thereby minimising the long term musculo-skeletal morbidity associated with open surgery. The introduction of growth induction by external traction (Foker procedure) for the treatment of long-gap OA has provided an important tool enabling increased preservation of the native oesophagus. Despite this, long-gap OA still poses a number of challenges, and oesophageal replacement still may be required in some cases.
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11
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Ho AMH, Dion JM, Wong JC. Airway and Ventilatory Management Options in Congenital Tracheoesophageal Fistula Repair. J Cardiothorac Vasc Anesth 2016; 30:515-20. [DOI: 10.1053/j.jvca.2015.04.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Indexed: 01/29/2023]
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12
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Chen IC, Lin JY, Yang SN, Dai ZK. Congenital bronchoesophageal fistula repaired by bronchoscopy-assisted fistulectomy in a neonate. Kaohsiung J Med Sci 2014; 30:53-4. [PMID: 24388060 DOI: 10.1016/j.kjms.2013.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 09/14/2012] [Indexed: 11/24/2022] Open
Affiliation(s)
- I-Chen Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jao-Yu Lin
- Department of Pediatric Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - San-Nan Yang
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Pediatrics, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Zen-Kong Dai
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Pediatrics, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Tröbs RB, Finke W. Endoscopic Detection and Surgical Repair of Congenital Tracheo-Esophageal-Fistula (TEF) ± Esophageal Atresia (EA). ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojped.2014.44039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Blázquez E, Laguillo JL, Ariza MA, Avilez TS, López-Millán JM. [Anesthetic management of a neonate with esophageal atresia, tracheoesophageal fistula and imperforate anus]. ACTA ACUST UNITED AC 2012; 60:589-93. [PMID: 23260992 DOI: 10.1016/j.redar.2012.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 09/26/2012] [Accepted: 10/01/2012] [Indexed: 11/20/2022]
Abstract
Esophageal atresia is a rare condition (1:2,500-4,500), incompatible with life, and a surgical emergency in the neonatal period. It is associated with prematurity in 30% of cases, and to congenital abnormalities in 50% of cases, especially cardiac anomalies. Major congenital heart diseases and low weight are independent predictors of mortality and critical perioperative events. The aim of this article is to describe the most significant anaesthetic challenges presented in a case of a term neonate undergoing emergency surgery after being diagnosed with esophageal atresia, tracheoesophageal fistula type iiib/C, and imperforate anus. The major priorities during the anaesthetic management consist of establishing a safe airway and effective pulmonary ventilation that minimises air leakage to the upper digestive tract.
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Affiliation(s)
- E Blázquez
- Servicio de Anestesiología, Hospital Universitario Virgen Macarena, Sevilla, España.
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Amat F, Heraud MC, Scheye T, Canavese M, Labbé A. Flexible bronchoscopic cannulation of an isolated H-type tracheoesophageal fistula in a newborn. J Pediatr Surg 2012; 47:e9-10. [PMID: 23084237 DOI: 10.1016/j.jpedsurg.2012.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 04/29/2012] [Accepted: 05/03/2012] [Indexed: 01/16/2023]
Abstract
Congenital isolated H-type tracheoesophageal fistula (H-TEF) is a rare malformation of the airways. Surgery should not be delayed once the diagnosis is established. Identification of the fistula during surgery is a prerequisite for a successful outcome. Intubation or cannulation of the H-TEF with a catheter can help the surgeon to identify the fistula. A rigid bronchoscope is generally used for cannulation of the fistula. Cannulation of an H-TEF in a newborn with a flexible bronchoscope has the merit of simplicity and safety. We report the insertion of a catheter in an isolated H-TEF in a newborn using a flexible bronchoscope and think that this method can be easily applied.
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Affiliation(s)
- Flore Amat
- Unit of Pediatric Pulmonology, CHU-Estaing-University Teaching Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
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Abstract
This article reviews (a) risk factors and preoperative considerations of the patient with tracheoesophageal fistula, (b) anesthetic management, including (i) airway management, (ii) induction of anesthesia and monitoring and (iii) postoperative disposition, (c) considerations for concomitant congenital heart disease, (d) considerations for thoracoscopic repair and (e) long-term outcomes and considerations of the patient with repaired esophageal atresia/tracheoesophageal fistula.
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Affiliation(s)
- Natasha Broemling
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, University of Toronto, Toronto, Canada.
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Alabbad SI, Shaw K, Puligandla PS, Carranza R, Bernard C, Laberge JM. The pitfalls of endotracheal intubation beyond the fistula in babies with type C esophageal atresia. Semin Pediatr Surg 2009; 18:116-8. [PMID: 19349003 DOI: 10.1053/j.sempedsurg.2009.02.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The intraoperative management of a neonate with esophageal atresia (EA) and distal tracheoesophageal fistula (TEF) is a true anesthetic challenge. Pediatric anesthesia textbooks recommend a distal tracheal intubation beyond the fistula and spontaneous ventilation, if possible, until surgical control of the fistula is achieved to minimize gastric distention. A full-term neonate with Trisomy 21 presented with an EATEF and was transferred to the operating theater for repair after appropriate evaluation. After induction of anesthesia, a size 3.0 endotracheal tube was inserted orally with confirmation of its position by good air entry and chest movement bilaterally. After positioning for thoracotomy, the patient desaturated and became bradycardic with abdominal distention. Despite reintubation, gastric needle decompression, and bilateral pleural aspiration to exclude pneumothorax, cardiopulmonary resuscitation was unsuccessful and the child died. Autopsy revealed the endotracheal tube in the trachea with its distal end passing through a large distal TEF. Preoperative bronchoscopy may help the team to assess the size and location of the distal TEF and plan for the best anesthetic strategy. It may also be useful to confirm tube location after endotracheal intubation and intraoperatively in the event of cardiorespiratory instability.
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Affiliation(s)
- Saleh I Alabbad
- Division of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
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