TEF

• 30% premature, associated CHD, and VATER, VACTREL syndromes

• Depend on the infant stability if stable complete repair, if not stage repair, with
insertion of G-tube under LA, the ligation of the fistula, and reanastomosis of the
esophagus
A→ subglottic stenosis
B→ resp distress, RDS, pneumonia
C→ CHD, decompensation and CHF
M→ dehydration, metabolic acidosis
• Worm up the room, big IV, standard CAS monitors, Art-line
• Lab→ CBC-D, lytes, ABG, Cap gas or VBG, CXR, Echo, X-match with 2U peds
in the room
• Give atropine, not muscle relaxant until chest open,
• Inhalation induction → bronch, then intubate after further mask ventilation to
deepen the Pt, have different size ETT, after intubation with the bevel directed
posteriorly, listen to the chest and initially intubate the Rt main bronchus, with
listening to the chest withdraw the tube slowly till you here bilateral breath sound.
• Consider caudal epidural for post-op pain
• Run maintenance fluids with glucose maintenance as well