title: An audit of anesthetic management and complications of tracheo-esophageal fistula and esophageal atresia repair.
abstract: BACKGROUND
  Many different anesthetic techniques have been suggested for the management of tracheo-oesophageal fistula/oesophageal atresia (TOF/OA) although the incidence of ventilation difficulty is not well known and it is unclear which technique is best in managing this. The aim of our audit was to determine the incidence of ventilation difficulty during repair of TOF/OA. We also recorded the current practice for anesthesia and analgesia in these children as well as the incidence of comorbidities and surgical complications.
  
  
  METHODS
  We retrospectively audited cases of TOF/OA repair over a 3-year period in four hospitals, recording demographics, comorbidities, surgical data, postoperative complications, and anesthetic technique, including ventilation difficulty and management strategy.
  
  
  RESULTS
  A total of 111 patients were identified with TOF/OA, and 106 patient notes and 101 anesthetic records were found. 42% of patients were premature, and 57.5% had significant comorbidities. Death was most likely in infants with low birth weight and low gestational age at birth and in those with major cardiac comorbidity. A range of techniques were used for induction, maintenance, extubation, and pain control. There were ventilation difficulties recorded at induction in seven patients, and significant desaturations were recorded in 15 patients intraoperatively.
  
  
  CONCLUSIONS
  This audit adds to the data already published about incidences of complications and comorbidities associated with TOF/OA repair. Defining anesthetic practice with regard to ventilation and analgesic strategies is important in comparing the adequacy and risk of techniques used. Our audit shows that a range of differing anesthetic techniques are still employed by different anesthetists and institutions and details some of the techniques being used for managing difficult ventilation.
authors.affiliation: Starship Hospital, Auckland, New Zealand. grahamk@adhb.govt.nz
authors.forename: Graham
authors.initials: G
authors.lastname: Knottenbelt
authors.forename: David
authors.initials: D
authors.lastname: Costi
authors.forename: Philip
authors.initials: P
authors.lastname: Stephens
authors.forename: Richard
authors.initials: R
authors.lastname: Beringer
authors.forename: Andrew
authors.initials: A
authors.lastname: Davidson
mesh_terms: D060666:Airway Extubation / Q000379:methods; D000698:Analgesia; D000758:Anesthesia; D001315:Australia; D054869:Clinical Audit; D004933:Esophageal Atresia / Q000601:surgery*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D007442:Intubation, Intratracheal; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012120:Respiration Disorders / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D014138:Tracheoesophageal Fistula / Q000151:congenital / Q000601:surgery*