Anesthesia and Ventilation for Thoracoscopic Esophageal Atresia Repair

This chapter aims to give an insight into the factors influencing anesthesia management of a neonate undergoing thoracoscopic repair of tracheoesophageal fistula (TEF). The inefficient respiratory mechanics of the neonate are further compromised by general anesthesia, lateral positioning, and capnothorax during thoracoscopic TEF repair. Preoperatively attention should be paid for prevention and management of aspiration pneumonitis and detection of associated anomalies especially cardiac defects as well as correction of fluid and pH abnormalities prior to induction of anesthesia. Anesthesia induction can be done via either intravenous or inhalational route. Using neuromuscular blockers prior to intubation is controversial. The aim while securing the airway is to isolate the fistula and prevent gastric distension using a variety of methods. These include awake intubation, withdrawal of tube after deliberate endotracheal intubation, and placement of Fogarty catheter in the fistula. Under capnothorax, one-lung ventilation can be done using either selective endobronchial intubation or by using a Fogarty catheter as a bronchial blocker. The ventilation strategy includes maintenance of oxygenation with permissible hypercarbia generally achieved with pressure-controlled ventilation (PCV) mode of ventilation. Evidence for safe and best practices for providing anesthesia to these neonates is still sparse. Postoperative elective ventilation is recommended for select patients.