Anesthetic Concerns in Open Versus Closed Repair of TEF (Tracheo-Esophageal Fistula) in Neonates

Tracheoesophageal fistula (TEF) with and without esophageal atresia (EA) is one of the most challenging and relatively common congenital anomalies (Knottenbelt et al., Best Pract Res Clin Anaesthesiol 24:387–401, 2010). It is heterogenous in nature, involving both genetic and environmental factors. Given the large proportion of TEF neonates with other major congenital anomalies, most notably VACTERL association, identification of these defects should be a primary focus. Ideal surgical management of TEF includes division of the fistula and primary esophageal repair in one operation (Healey et al., Arch Surg 133:552–556, 1998). Thoracoscopic repair has been performed with increasing frequency and success over the last two decades. Anesthetic management poses many intraoperative challenges, the most common of which is interference with ventilation. For a successful outcome, the postoperative care should continue with the surgical team working closely with neonatal intensivists, nurses, and parents regarding plans for airway support, intravenous fluids, antibiotics, parenteral nutrition, and pain management.