title: Anaesthetic management in a case of a type IV laryngotracheo-oesophageal cleft.
abstract: We report the case of a newborn baby with a type IV laryngotracheo-oesophageal cleft and the anaesthetic management during the rigid bronchoscopy that was performed at 5 days of age. After anaesthetic induction with sevoflurane and atropine, the child was maintained with sevoflurane 2-2.5% and remifentanil at an infusion rate of 0.5 microg.kg(-1).min(-1). Ventilation was managed through the lateral port of the bronchoscope. The patient breathed sevoflurane and oxygen/N2O spontaneously via a Jackson-Rees circuit. To prevent the stomach from filling up with anaesthetic gases, a Foley catheter was placed orally into the stomach. The Foley balloon was inflated and retracted until it sealed the gastro-oesophageal junction. Tracheal intubation was performed after bronchoscopy to allow suture of the stomach into two chambers. Oxygenation was adequate with no air leakage, with spontaneous ventilation. The Foley catheter was removed afterwards and the patient awakened. We review the literature on different ways of managing the airway in these cases and protecting it from gastric aspiration during ventilation.
authors.affiliation: Paediatric Anaesthesiology Division, University Hospital Doce de Octubre, Madrid, Spain. fdezba@yahoo.es
authors.forename: A
authors.initials: A
authors.lastname: Fernández
authors.forename: A
authors.initials: A
authors.lastname: Jerez
authors.forename: N
authors.initials: N
authors.lastname: Falcone
mesh_terms: D000015:Abnormalities, Multiple; D000759:Adjuvants, Anesthesia / Q000627:therapeutic use; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D001285:Atropine / Q000627:therapeutic use; D001999:Bronchoscopy; D004947:Esophagus / Q000002:abnormalities*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D007830:Larynx / Q000002:abnormalities*; D008738:Methyl Ethers / Q000627:therapeutic use; D010880:Piperidines / Q000627:therapeutic use; D000077208:Remifentanil; D000077149:Sevoflurane; D014132:Trachea / Q000002:abnormalities*
chemical_list: D000759:Adjuvants, Anesthesia; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D001285:Atropine; D000077208:Remifentanil