title: [Anesthetic management for surgery of esophagus atresia in a newborn with Goldenhar's syndrome].
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Serviço de Anestesiologia e Reanimação, Hospitais Universitários Virgen del Rocío, Sevilha, Espanha. Electronic address: rosanabixi7@hotmail.com.
authors.forename: Rosana
authors.initials: R
authors.lastname: Guerrero-Domínguez
authors.affiliation: Serviço de Anestesiologia e Reanimação, Hospitais Universitários Virgen del Rocío, Sevilha, Espanha.
authors.forename: Daniel
authors.initials: D
authors.lastname: López-Herrera-Rodríguez
authors.affiliation: Serviço de Anestesiologia e Reanimação, Hospitais Universitários Virgen del Rocío, Sevilha, Espanha.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Benítez-Linero
authors.affiliation: Serviço de Anestesiologia e Reanimação, Hospital Infantil, Hospitais Universitários Virgen del Rocío, Sevilha, Espanha.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ontanilla
keywords: Atresia de esôfago; Difficult airway; Esophageal atresia; Fibrobronchoscope; Fibrobroncoscópio; Fístula traqueoesofágica; Goldenhar's syndrome; Síndrome de Goldenhar; Tracheoesophageal fistula; Via respiratória difícil