Background and aims Anesthesia management of oesophageal-atresia with tracheo-oesophageal fistula (TOF) repair is a challenge. We report a 48-hour-old neonate, 3050 g (>75 percentile) scheduled for TOF repair.
Methods Patient was born at 37 weeks gestation. There were no other coexisting anomalies found. There was a Type-C TOF.
Anesthetic plan is combined anesthesia with a thoracic epidural catheter. After routine monitoring general anesthesia induced with sevoflurane%3. While maintaining spontaneous ventilation surgeon perform a rigid-bronchoscopy determined that the fistula is at most distal part of carina. Endotracheal tube is placed and try to preserve spontaneous ventilation so not to inflate the stomach. Within right lateral position ultrasonographic examination done, anatomic structures and epidural depth is defined. Epidural space is determined at 1,3 cm depth with loss of air method through 20G toughy needle. Epidural catheter was placed at 4th thoracic level.%0,1 bupivacaine 1 ml is given for epidural anesthesia. Sevoflurane is reduced to%1,5 during surgery. During right thoracotomy surgeon requested muscle-relaxation. Surgery took 180 minutes. Because it was a complex TOF-repair patient transferred remained intubated to the neonatal intensive-care unit.
Results During postoperative period%0,1 bupivacaine 1,5 ml.h-1 infusion started. Minimal sedation needed. Two attempts of extubation failed because of stridor and forced ventilation. Patient extubated at 5th postoperative day and continued with nasal CPAP. Epidural catheter taken out at 5th postoperative day.
Conclusions Regional anesthesia reduces stress response and sedation requirements in neonates. Ultrasonography is a valuable tool for neuroaxial techniques especially for neonates. With the aid of ultrasonography, failure rates and complications are also reduced.
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