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van den Berg J, Johansen M, Disma N, Engelhardt T, Hansen TG, Veyckemans F, Zielinska M, de Graaff JC. Perioperative anaesthetic management and short-term outcome of neonatal repair of oesophageal atresia with or without tracheo-oesophageal fistula in Europe: A sub-analysis of the neonate and children audit of anaesthesia practice in Europe (NECTARINE) prospective multicenter observational study. Eur J Anaesthesiol 2023; 40:936-945. [PMID: 37779460 DOI: 10.1097/eja.0000000000001905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND Oesophageal atresia with or without a tracheo-oesophageal fistula is a congenital abnormality that usually requires surgical repair within the first days of life. OBJECTIVE Description of the perioperative anaesthetic management and outcomes of neonates undergoing surgery for oesophageal atresia with or without a tracheo-oesophageal fistula, included in the 'neonate and children audit of anaesthesia practice in Europe' (NECTARINE) database. DESIGN Sub-analyses of prospective observational NECTARINE study. SETTING European multicentre study. PATIENTS Neonates who underwent surgery for oesophageal atresia with or without a tracheo-oesophageal fistula in the NECTARINE cohort were selected. MAIN OUTCOME MEASURES Incidence rates with 95% confidence intervals were calculated for peri-operative clinical events which required a predetermined intervention, postoperative complications, and mortality. RESULTS One hundred and three neonates undergoing a first surgical intervention for oesophageal atresia with or without a tracheo-oesophageal fistula repair were identified. Their median gestational age was 38 weeks with a median birth weight of 2840 [interquartile range 2150 to 3150] grams. Invasive monitoring was used in 66% of the procedures. The incidence of perioperative clinical events was 69% (95% confidence interval 59 to 77%), of 30-day postoperative complications 47% (95% confidence interval 38 to 57%) and the 30- and 90 days mortality rates were 2.1% and 2.6%, respectively. CONCLUSION Oesophageal atresia with or without a tracheo-oesophageal fistula repair in neonates is associated with a high number of perioperative interventions in response to clinical events, a high incidence of postoperative complications, and a substantial mortality rate.
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Affiliation(s)
- Johanneke van den Berg
- From the Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands (M.JVDB), Division of Pediatric Anaesthesia, Montreal Children's Hospital, McGill University Centre, Montreal, Canada (MJ), Unit for Research & Innovation, Department of Anaesthesia, IRCCS Istituto Giannina Gaslini, Genova, Italy (ND), Department of Anaesthesia, Montreal Children's Hospital, Montreal, QC, Canada (TE), Department of Anaesthesia, Akershus University Hospital and Oslo University, Oslo, Norway (TGH), Clinique d'Anesthésie-Réanimation pédiatrique, Hôpital Jeanne de Flandre, CHU de Lille, Lille, France (FV), Department of Paediatric Anaesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw, Poland (MZ), Department of Anesthesiology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands, Adrz-EramusMC, Goes, The Netherlands (JCDG)
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Knottenbelt G. Anaesthesia for surgery in infancy. ANAESTHESIA & INTENSIVE CARE MEDICINE 2022. [DOI: 10.1016/j.mpaic.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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3
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Waghmarae S, Manitshana N, Motshabi Chakane P. Perioperative management and outcomes of neonates undergoing anaesthesia for congenital tracheo-oesophageal fistula repair at Charlotte Maxeke Johannesburg academic hospital. Pediatr Surg Int 2022; 38:1909-1917. [PMID: 36152075 DOI: 10.1007/s00383-022-05251-7] [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] [Accepted: 09/16/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Congenital tracheo-oesophageal fistula (TOF) occurs in 1 in 3000 births. Perioperative management for TOF repair requires co-ordination with a multi-disciplinary team, support from critical care units, and expertise in neonatal and cardiothoracic anaesthesia. Charlotte Maxeke Johannesburg academic hospital (CMJAH) is a quaternary referral centre that serves the regional community of Johannesburg, in Gauteng, South Africa. The aim of this research was to describe the perioperative outcomes of neonates undergoing surgical TOF repair at CMJAH. Factors in the preoperative, intra-operative, and postoperative management were considered to find relationships with the perioperative outcomes. METHOD A retrospective single institution study was conducted with a population of 38 neonates who underwent congenital TOF repair from 1 January 2015 to 31 March 2020 at CMJAH. Descriptive statistics were used to describe the biodata using percentages, median, and inter-quartile ranges. An in-depth description of neonates that died was performed. RESULTS A total of 38 neonates diagnosed with TOF/OA were operated on during the study period. The mortality rate was 15.8%. No deaths occurred intraoperatively. In addition, 52.6% of the neonates had a prolonged stay in ICU, 44% had a delay in the initiation of feeds, 65% developed sepsis, and 36.8% had surgical related complications. CPR was required in 1 neonate, hypoxia leading to bradycardia in 10, and hyperlactataemia in 9 neonates. Inotropic support was required in 6 neonates, and vasopressor support in 4. Blood product transfusion were necessary for 9 neonates. CONCLUSION The in-hospital mortality of TOF repair was better than that reported in other African countries and worse than international findings. In-hospital morbidity was burdened by respiratory illness and sepsis. Areas where management could be improved include widespread foetal anomaly scanning, incorporation of bronchoscopy, and preoperative respiratory optimisation.
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Affiliation(s)
- Sweeka Waghmarae
- Department of Anaesthesia, University of Witwatersrand, Johannesburg, Gauteng, South Africa.
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4
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Hemi FK, Jozef A, Taishori N, Ismail N, Ali W, Omran A. Proximal congenital esophageal stenosis associated with tracheo-esophageal fistula. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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The Phenotypical Profile and Outcomes of Neonates with Congenital Tracheoesophageal Fistula Associated with Congenital Cardiac Anomalies Presenting for Surgery. CHILDREN 2022; 9:children9060887. [PMID: 35740824 PMCID: PMC9221898 DOI: 10.3390/children9060887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/23/2022]
Abstract
(1) Background: Neonates born with oesophageal atresia and/or tracheooesophageal fistula (OA/TOF) are usually born with a multitude of other congenital anomalies, which may affect their anaesthetic care and survival to hospital discharge. We reviewed the profile and outcome of neonates with OA/TOF and associated congenital cardiac anomalies presenting for surgery at an academic hospital in South Africa. (2) Methods: A retrospective, cross-sectional analysis of all medical records of neonates who had undergone surgical repair of OA/TOF was conducted at an academic hospital between January 2015 and December 2019. Descriptive statistics were used to report the data. Comparisons in perioperative events and outcomes between those with cardiac lesions and those without were done. (3) Results: Neonates presenting for OA/TOF repair with congenital cardiac defects had an incidence of 62 [95% CI 38.5–99.8] per 1000 days since birth. In total, 45.9% had associated cardiac anomalies, with PDA and ASD as the most prevalent lesions. There were statistically significant differences in intraoperative adverse events seen in neonates with congenital cardiac lesions as compared to those without. (4) Conclusion: Despite advances in neonatal critical care and anaesthetic and surgical techniques, OA/TOF associated with congenital cardiac anomalies is still associated with high mortality rates in developing countries.
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Balkisson M, Kusel B, Torborg AM. A retrospective review of the perioperative management of patients with congenital oesophageal atresia and tracheo-oesophageal fistula at a South African third level hospital. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2022. [DOI: 10.36303/sajaa.2022.28.3.2685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- M Balkisson
- Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal,
South Africa
| | - B Kusel
- Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal,
South Africa
| | - AM Torborg
- Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal,
South Africa
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Murray-Torres TM, Winch PD, Naguib AN, Tobias JD. Anesthesia for thoracic surgery in infants and children. Saudi J Anaesth 2021; 15:283-299. [PMID: 34764836 PMCID: PMC8579498 DOI: 10.4103/sja.sja_350_20] [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: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/19/2022] Open
Abstract
The management of infants and children presenting for thoracic surgery poses a variety of challenges for anesthesiologists. A thorough understanding of the implications of developmental changes in cardiopulmonary anatomy and physiology, associated comorbid conditions, and the proposed surgical intervention is essential in order to provide safe and effective clinical care. This narrative review discusses the perioperative anesthetic management of pediatric patients undergoing noncardiac thoracic surgery, beginning with the preoperative assessment. The considerations for the implementation and management of one-lung ventilation (OLV) will be reviewed, and as will the anesthetic implications of different surgical procedures including bronchoscopy, mediastinoscopy, thoracotomy, and thoracoscopy. We will also discuss pediatric-specific disease processes presenting in neonates, infants, and children, with an emphasis on those with unique impact on anesthetic management.
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Affiliation(s)
- Teresa M Murray-Torres
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Peter D Winch
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Aymen N Naguib
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Kaufmann J, Laschat M, Schieren M, Böckenholt K, Klein T, Wappler F. Hypopharyngeal Perforation Mimicking Esophageal Atresia: A Case Report of an Extremely Low Birth Weight Infant Emphasizing the Need for Preoperative Endoscopy. A A Pract 2021; 15:e01414. [PMID: 33684085 DOI: 10.1213/xaa.0000000000001414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a case of an extremely low birth weight premature infant born at 27 weeks of gestation, transferred to our tertiary pediatric referral center for surgical repair of an esophageal atresia. Endoscopic evaluation before the start of surgery revealed a hypopharyngeal perforation, resulting in the false impression of esophageal atresia. If no tracheoesophageal fistula is found during tracheoscopy, esophagoscopy should be done before surgical intervention as the inability to pass a nasogastric tube into the stomach is not sufficiently reliable for a correct diagnosis of esophageal atresia.
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Affiliation(s)
- Jost Kaufmann
- From the Department for Pediatric Anesthesia and Endoscopy, Children's Hospital, Cologne, Germany.,Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Michael Laschat
- From the Department for Pediatric Anesthesia and Endoscopy, Children's Hospital, Cologne, Germany
| | - Mark Schieren
- From the Department for Pediatric Anesthesia and Endoscopy, Children's Hospital, Cologne, Germany.,Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Kai Böckenholt
- Clinic for Pediatrics, Department for Neonatal Intensive Care, Children's Hospital, Cologne, Germany, Children's Hospital, Cologne, Germany
| | - Tobias Klein
- Clinic for Pediatric Surgery and Urology, Children's Hospital, Cologne, Germany
| | - Frank Wappler
- From the Department for Pediatric Anesthesia and Endoscopy, Children's Hospital, Cologne, Germany.,Faculty of Health, University of Witten/Herdecke, Witten, Germany
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Kim W, Son J, Lee S, Seo JM. The learning curve for thoracoscopic repair of esophageal atresia with distal tracheoesophageal fistula: A cumulative sum analysis. J Pediatr Surg 2020; 55:2527-2530. [PMID: 32646663 DOI: 10.1016/j.jpedsurg.2020.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/26/2020] [Accepted: 06/05/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (EA/TEF) remains technically challenging due to the rarity of these procedures. The aim of this study is to report our experience with thoracoscopic repair of type C EA/TEF and to evaluate the learning curve based upon the surgeon's skill level. METHODS We retrospectively reviewed data of thoracoscopic EA/TEF repair performed in our center between October 2008 and May 2019. The learning curve was evaluated using the cumulative sum (CUSUM) method based on operative time. RESULTS Of the 50 consecutive cases evaluated, the mean birth weight was 2634 ± 608 g and the median age at operation was 3 days (range, 1-29 days). The mean operation time was 144 ± 65 min. Anastomosis leakage occurred in 3 cases (6%) and strictures requiring balloon dilatations occurred in 16 cases (32%). The CUSUM analysis evaluated a learning curve of approximately 10 cases of thoracoscopic type C EA/TEF repair. A lower gestational age was associated with longer operation time. CONCLUSIONS Thoracoscopic repair of type C EA/TEF is a feasible and safe procedure. The number of procedures required to achieve a stable learning curve was 10. The learning phase may be shortened by adequate set-up under the supervision of an expert endoscopic surgeon. TYPE OF STUDY Retrospective Comparative Treatment Study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Wontae Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joonhyuk Son
- Department of Pediatric Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Sanghoon Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Jeong-Meen Seo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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10
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Risk factors of early mortality after neonatal surgery in Tunisia. J Pediatr Surg 2020; 55:2233-2237. [PMID: 32654833 DOI: 10.1016/j.jpedsurg.2020.05.035] [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: 07/29/2019] [Revised: 05/19/2020] [Accepted: 05/29/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Research concerning factors of death after neonatal surgery is scarce. Insight into mortality might improve perioperative care. This study aimed to identify predictive factors of mortality after neonatal surgery in a low income country (LIC). METHODS Charts of all newborn patients who underwent surgical procedures under general anesthesia during the neonatal period in our department of pediatric surgery between January 2010 and December 2017 were reviewed. We used univariate and multivariate analysis to evaluate perioperative variables potentially predictive of early postoperative mortality. RESULTS One hundred eighty-two cases were included in the study: 41 newborns (28.6%) were premature (<37 weeks of gestation) and 52 (22.5%) weighed less than 2.5 kg. The most commonly diagnosed conditions were esophageal atresia (24%) and bowel obstruction (19%). Forty-four patients (24%) died during hospitalization. The highest rate of mortality was observed for congenital diaphragmatic hernia. Univariate analysis showed that perinatal predictive variables of mortality were prematurity, low birth weight, the necessity of preoperative intubation, and duration of surgery more than 2 h. Logistic regression showed three independent risk factors, which are the duration of surgery, low birth weight and the necessity of preoperative intubation. CONCLUSION The overall mortality in infants undergoing neonatal surgery is still high in LICs. Knowledge of independent risk factors of early mortality may help clinicians to more adequately manage the high-risk population. TYPE OF THE STUDY Clinical research paper. LEVEL OF EVIDENCE III.
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11
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Son J, Jang Y, Kim W, Lee S, Jeong JS, Lee SK, Seo JM. Thoracoscopic repair of esophageal atresia with distal tracheoesophageal fistula: is it a safe procedure in infants weighing less than 2000 g? Surg Endosc 2020; 35:1597-1601. [PMID: 32323019 PMCID: PMC7222104 DOI: 10.1007/s00464-020-07538-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 03/31/2020] [Indexed: 11/28/2022]
Abstract
Background Since Rothenberg first performed thoracoscopic repair for esophageal atresia with distal tracheoesophageal fistula (EA/TEF) successfully in 2000, thoracoscopic repair has achieved status as a routine procedure worldwide. Previously, an international multicenter study reported that this procedure was not inferior to conventional open surgery. However, thoracoscopic surgery is a highly difficult operation for surgeons and anesthesiologists; as a result, the safety and efficacy of the surgery is still under debate. Considering these circumstances, the purpose of this study was to analyze the results of single-center thoracoscopic surgery and to compare the outcomes relative to the patient’s weight at the time of surgery. Methods We retrospectively analyzed patients with EA/TEF who underwent thoracoscopic surgery in a single center between October 2008 and February 2017. Results In total, 41 cases of thoracoscopic repair of EA/TEF were performed. Upon subgrouping by over and under 2000 g of body weight at the time of operation, 34 were found to be over 2000 g and seven were under 2000 g. Intraoperative factors and events were not significantly different between the two groups. Additionally, most of the postoperative outcomes, including the rate of postoperative leakage and strictures, showed no difference. On the other hand, the under 2000 g group had more gastroesophageal reflux requiring fundoplication than did the heavier group (P = 0.04). Conclusions The results of this center’s thoracoscopic repair of EA/TEF were not inferior to other centers’ outcomes. Additionally, the intraoperative and postoperative outcomes were similar despite differences in weight at operation. Therefore, thoracoscopic repair might be a feasible surgical option for infants weighing less than 2000 g when performed by a surgeon and anesthesiologist team who are experienced in pediatric thoracoscopic surgery.
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Affiliation(s)
- Joonhyuk Son
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Yerang Jang
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Wontae Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Sanghoon Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Ji Seon Jeong
- Department of Anesthesiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk-Koo Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Jeong-Meen Seo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.
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Holmquist A, Granholm T, Ehrén H, Burgos CM. Closer location of the tracheoesophageal fistula to the carina in newborns with esophageal atresia and VACTERL association. J Pediatr Surg 2019; 54:1312-1315. [PMID: 30503021 DOI: 10.1016/j.jpedsurg.2018.10.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/18/2018] [Accepted: 10/21/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND VACTERL is a complicated syndrome with an unknown etiology where many studies have failed to identify the cause. In esophageal atresia (EA) roughly 10%-23% also have concurrent anomalies that align with VACTERL disorder. The aim of this study is to investigate if there is a difference regarding localization of the tracheoesophageal fistula between patients with VACTERL and non-VACTERL patients. METHODS Retrospective chart review of newborn operated for esophageal atresia between 2006 and 2016 at our Institution was performed. Children with a C-type fistula according to Gross and reliable preoperative tracheoesophageal fistula to carina distance measurement at rigid tracheoscopy were included in the study. RESULTS A total of 90 patients were included in the study. Fifteen of those were diagnosed with VACTERL. Before and after adjusting for weight and gestational week patients with VACTERL had significantly shorter carina to fistula distance at perioperative rigid tracheoscopy (p = <0.001 nonadjusted, p = 0.016 adjusted). CONCLUSION Patients with VACTERL born with EA type C had shorter carina to fistula distance as shown at perioperative rigid tracheoscopy. The significantly shorter distance may not only present surgical difficulties but may also suggest a structural or molecular difference in the development of the esophageal atresia between the two groups. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anders Holmquist
- Department of pediatric surgery, Karolinska University Hospital, Stockholm, Sweden.
| | - Tina Granholm
- Department of pediatric surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Ehrén
- Department of pediatric surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Carmen Mesas Burgos
- Department of pediatric surgery, Karolinska University Hospital, Stockholm, Sweden
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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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Powell L, Frawley J, Crameri J, Teague WJ, Frawley GP. Oesophageal atresia: Are "long gap" patients at greater anesthetic risk? Paediatr Anaesth 2018; 28:249-256. [PMID: 29399924 DOI: 10.1111/pan.13336] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Long gap oesophageal atresia occurs in approximately 10% of all oesophageal atresia infants and surgical repair is often difficult with significant postoperative complications. Our aim was to describe the perioperative course, morbidity, and early results following repair of long gap oesophageal atresia and to identify factors which may be associated with complications. METHODS This is a single center retrospective cohort study of consecutive patients with oesophageal atresia undergoing surgical repair at The Royal Children's Hospital Melbourne from January 2006 to June 2017. RESULTS Two hundred and thirty-nine consecutive oesophageal atresia infants included 44 long gap oesophageal atresia infants and 195 non-long gap infants. A high rate of prematurity (24.7%), major cardiac (17%), and other surgically relevant malformations (12.6%) was found in both groups. The median age at oesophageal anastomosis surgery was 65.5 days for the long gap group vs 1 day for the oesophageal atresia group (mean difference 56.8 days, 95% CI 48.1-65.5 days, P < .01). Surgery for long gap oesophageal atresia included immediate primary anastomosis (n = 10), delayed primary anastomosis (n = 11), oesophageal lengthening techniques (n = 12) and primary oesophageal replacement (n = 6). Long gap oesophageal atresia was not associated with an increased incidence of difficult intubation (OR 2.8, 95% CI 0.6-22.1, P = .17), intraoperative hypoxemia (OR 1.6, 95% CI 0.6-4.5, P = .32), or hypotension (OR 0.9, 95% CI 0.5-1.8, P = .81). The surgical duration (177.7 vs 202.1 minute, mean difference [95% CI], 28 [5.5-50.4 minutes], P = .04) and mean duration of postoperative mechanical ventilation (107 vs 199.8 hours, mean difference [95% CI], 91.8 [34.5-149.1 hours], P < .01) were shorter for the non-long gap group. Overall in-hospital mortality was 7.5% (15.9% long gap vs 5.6% non-long gap oesophageal atresia OR 1.1, 95% CI 0.4-3.4, P = .85). CONCLUSION Long gap oesophageal atresia infants have a similar incidence of perioperative complications to other infants with oesophageal atresia. Current surgical approaches to long gap repair, however, are associated with longer anesthetic exposures and require multiple procedures in infancy to achieve oesophageal continuity.
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Affiliation(s)
- Laura Powell
- Department of Paediatric Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Vic., Australia
| | - Jacinta Frawley
- Department of Paediatric Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Vic., Australia
| | - Joe Crameri
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Vic., Australia
| | - Warwick J Teague
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - Geoff P Frawley
- Department of Paediatric Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Critical Care and Neuroscience Group, Murdoch Children's Research institute, Melbourne, Vic., Australia
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15
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Tollinche LE, Chawla M, Lee EW, Rolando Peralta A. Collaborating with interventional pulmonology in managing a massive tracheoesophageal fistula that extends from cricoid to carina: a case report. JA Clin Rep 2018; 3:62. [PMID: 29457105 PMCID: PMC5804658 DOI: 10.1186/s40981-017-0133-2] [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: 11/06/2017] [Accepted: 11/24/2017] [Indexed: 11/18/2022] Open
Abstract
Tracheoesophageal fistulas (TEF) present a perioperative management challenge. A 62 year-old man with esophageal carcinoma presented with a large tracheoesophageal fistula extending most of the trachea. Previously, the patient had two overlapping esophageal and one tracheal stent placed, but he developed progressive tracheal disruption due to esophageal stent perforation near the level of the cricoid. This case describes the anesthetic management of tracheal stent placement for an expanding TEF. Management included a spontaneous breathing inhalation induction followed by ventilation through a supraglottic device—laryngeal mask airway (LMA). Finally, during rigid bronchoscopy, a combination of bag ventilation and jet ventilation was utilized.
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Affiliation(s)
- Luis E Tollinche
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C330F, New York, NY 10065 USA
| | - Mohit Chawla
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C330F, New York, NY 10065 USA
| | - Eunice W Lee
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C330F, New York, NY 10065 USA
| | - A Rolando Peralta
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C330F, New York, NY 10065 USA
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16
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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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17
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18
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Peri-operative management of neonates with oesophageal atresia and tracheo-oesophageal fistula. Paediatr Respir Rev 2016; 19:3-9. [PMID: 26921972 DOI: 10.1016/j.prrv.2016.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 01/21/2016] [Indexed: 01/27/2023]
Abstract
Oesphageal atresia is a relatively common congenital anomaly that requires urgent diagnosis, transfer to a neonatal surgical centre and management by a multidisciplinary team. Peri-operative management requires vigilant monitoring for the many possible associated morbidities. There are unique anaesthetic, airway and ventilatory considerations for this group of patients. Beyond the perinatal period, systematic neurodevelopmental follow-up is recommended to better understand the longer term outcomes for these children.
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19
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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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20
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Guerrero-Domínguez R, López-Herrera-Rodríguez D, Benítez-Linero I, Ontanilla A. Anesthetic management for surgery of esophagus atresia in a newborn with Goldenhar's syndrome. Braz J Anesthesiol 2015; 65:298-301. [PMID: 26123147 DOI: 10.1016/j.bjane.2013.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 07/19/2013] [Accepted: 07/25/2013] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Goldenhar's syndrome is a polymalformative condition consisting of a craniofacial dysostosis that determines difficult airway in up to 40% of cases. We described a case of a newborn with Goldenhar's syndrome with esophageal atresia and tracheoesophageal fistula who underwent repair surgery. CASE REPORT We report the case of a 24-h-old newborn with Goldenhar's syndrome. He had esophageal atresia with distal tracheoesophageal fistula. It was decided that an emergency surgery would be performed for repairing it. It was carried out under sedation, intubation with fibrobronchoscope distal to the fistula, to limit the air flow into the esophagus, and possible abdominal distension. Following complete repair of the esophageal atresia and fistula ligation, the patient was transferred to the intensive care unit and intubated under sedation and analgesia. CONCLUSIONS The finding of a patient with Goldenhar's syndrome and esophageal atresia assumes an exceptional situation and a challenge for anesthesiologists, since the anesthetic management depends on the patient comorbidity, the type of tracheoesophageal fistula, the usual hospital practice and the skills of the anesthesiologist in charge, with the main peculiarity being maintenance of adequate pulmonary ventilation in the presence of a communication between the airway and the esophagus. Intubation with fibrobronchoscope distal to the fistula deals with the management of a probably difficult airway and limits the passage of air to the esophagus through the fistula.
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Affiliation(s)
- Rosana Guerrero-Domínguez
- Service of Anesthesiology and Reanimation, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain.
| | | | - Inmaculada Benítez-Linero
- Service of Anesthesiology and Reanimation, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain
| | - Antonio Ontanilla
- Service of Anesthesiology and Reanimation, Hospital Infantil, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain
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21
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[Anesthetic management for surgery of esophagus atresia in a newborn with Goldenhar's syndrome]. Rev Bras Anestesiol 2015; 65:298-301. [PMID: 25960363 DOI: 10.1016/j.bjan.2013.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 07/25/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Goldenhar's syndrome is a polymalformative condition consisting of a craniofacial dysostosis that determines difficult airway in up to 40% of cases. We described a case of a newborn with Goldenhar's syndrome with esophageal atresia and tracheoesophageal fistula who underwent repair surgery. CASE REPORT We report the case of a 24-hour-old newborn with Goldenhar's syndrome. He had esophageal atresia with distal tracheoesophageal fistula. It was decided that an emergency surgery would be performed for repairing it. It was carried out under sedation, intubation with fibrobronchoscope distal to the fistula, to limit the air flow into the esophagus, and possible abdominal distension. Following complete repair of the esophageal atresia and fistula ligation, the patient was transferred to the intensive care unit and intubated under sedation and analgesia. CONCLUSIONS The finding of a patient with Goldenhar's syndrome and esophageal atresia assumes an exceptional situation and a challenge for anesthesiologists, since the anesthetic management depends on the patient comorbidity, the type of tracheoesophageal fistula, the usual hospital practice and the skills of the anesthesiologist in charge, with the main peculiarity being maintenance of adequate pulmonary ventilation in the presence of a communication between the airway and the esophagus. Intubation with fibrobronchoscope distal to the fistula deals with the management of a probably difficult airway and limits the passage of air to the esophagus through the fistula.
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22
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Hosking C, Motshabi-Chakane P. Thoracotomy in a spontaneously breathing neonate undergoing tracheo-oesophageal fistula repair. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2013.10872948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- C Hosking
- Department of Anaesthesia, Charlotte Maxeke Johannesburg Academic Hospital
| | - P Motshabi-Chakane
- Department of Anaesthesia, Charlotte Maxeke Johannesburg Academic Hospital
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23
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Abstract
PURPOSE OF REVIEW To keep pediatric anesthesiologists up-to-date in their management of pediatric emergencies by identifying the key publications from 2012 that are relevant to the anesthetic management of common pediatric emergencies. RECENT FINDINGS Little has been published about specific pediatric emergencies. A large multi-institutional audit of tracheo-esophageal fistula demonstrated a wide range of anesthesia practice and a difficulty with ventilation on induction in 7% of cases. Large audits of bronchoscopy for foreign body have also demonstrated a variety of effective practices with a low complication rate. More generally, studies have increasingly demonstrated that postoperative pain may be substantial after many common procedures including some emergency surgery. The management of the full stomach remains controversial and the use of ultrasound to assess gastric volume is promising but unproven. Recent guidelines for resuscitation have been published. It is increasingly recognized that meticulous management of pediatric brain injury is vital, and although the evidence base is very weak, a more coherent anesthetic approach is emerging. SUMMARY Many areas of the management of pediatric emergencies remain controversial and based on little good evidence. In spite of this, the complication rate is low. Postoperative pain is an emerging problem while the optimal management of the full stomach is still unresolved.
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Catré D, Lopes MF, Madrigal A, Oliveiros B, Cabrita AS, Viana JS, Neves JF. Fatores preditivos de complicações graves em cirurgia neonatal. Rev Col Bras Cir 2013; 40:363-9. [DOI: 10.1590/s0100-69912013000500003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 11/06/2012] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: investigar a incidência e gravidade das complicações pós-operatórias precoces e identificar fatores de risco para o seu desenvolvimento em recém-nascidos submetidos ao tratamento cirúrgico, sob anestesia geral. MÉTODOS: análise retrospectiva dos dados de 437 neonatos com doença crítica submetidos à cirurgia neonatal num centro cirúrgico pediátrico terciário, entre janeiro de 2000 e dezembro de 2010. A gravidade das complicações ocorridas nos primeiros 30 dias de pós-operatório foi classificada utilizando o sistema de Clavien-Dindo para complicações cirúrgicas, sendo considerados graves os graus III a V. Por análise estatística uni e multivariada avaliaram-se variáveis pré e intraoperatórias com potencial preditivo de complicações pós-operatórias graves. RESULTADOS: a incidência de, pelo menos, uma complicação grave foi 23%, com uma mediana de uma complicação por paciente 1:3. Ao todo, ocorreram 121 complicações graves. Destas, 86 necessitaram de intervenção cirúrgica, endoscópica ou radiológica (grau III), 25 puseram em risco a vida, com disfunção uni ou multi-órgão (grau IV) e dez resultaram na morte do paciente (grau V). As principais complicações foram técnicas (25%), gastrointestinais (22%) e respiratórias (21%). Foram identificados quatro fatores de risco independentes para complicações pós-operatórias graves: reoperação, operação por hérnia diafragmática congênita, prematuridade menor que 32 semanas de idade gestacional e cirurgia abdominal. CONCLUSÃO: a incidência de complicações pós-operatórias graves após cirurgias neonatais, sob anestesia geral, permaneceu elevada. As condições consideradas fatores de risco independentes para complicações graves após a cirurgia neonatal podem ajudar a definir o prognóstico pós-operatório em neonatos com doença cirúrgica e orientar as intervenções para melhoria de resultados.
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25
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Kwok WH, Wong MK, Ho AMH, Critchley LAH, Karmakar MK. Left mainstem bronchial tear manifesting as sudden upsurge in end-tidal CO2 during thoracoscopic tracheoesophageal fistula repair. J Cardiothorac Vasc Anesth 2012; 27:539-41. [PMID: 22795732 DOI: 10.1053/j.jvca.2012.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Wing H Kwok
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR
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