Canadian Journal of Anesthesia, Vol 19, 270-282, Copyright © 1972 by Canadian Anesthesiologists' Society

The Anaesthetic Management of Tracheo-Oesophageal Fistula: A Review of Ten Years Experience

¹ Department of Anaesthesia, Vancouver General Hospital, Vancouver 9, British Columbia, Canada

The overall survival rate in cases undergoing surgical correction of tracheo-oesophageal fistula at The Hospital for Sick Children, Toronto, has improved from 63.5 per cent in the 104 cases treated during the 1959-1963 period, to 78.3 per cent in the 83 cases treated during the 1964-1968 period. Cases in the two 5-year series were comparable with respect to the types of anomaly, the incidence of prematurity and associated congenital anomalies, and the age at operation. In the second series a higher incidence of pulmonary complications was recorded. In the second series the survival rate was 100 per cent in those cases over 1,800 gms without significant associated anomalies and/or pulmonary complications. There was also 100 per cent survival rate in group B₂.

Review of the survival rates indicates that the fate of many infants with tracheo-oesophageal fistula is probably determined by prematurity, associated anomalies and/or pulmonary complication before operation is undertaken.¹³ However, the 1964-1968 survival rate indicates that efforts to improve the anaesthetic and surgical management during pre-, per-, and post-operative periods can increase survival even in premature babies. The anaesthetic and postoperative management techniques have improved with more meticulous attention to details of the techniques of management and monitoring of the neonatal patient. The most obvious change in surgical management was the increased number of staged procedures in poor-risk patients. The overall improvement in management of these cases is also reflected in the markedly reduced proportion of the deaths which occur during the first 48 hours postoperatively.

In conclusion, babies undergoing general anaesthesia for surgical correction of tracheo-oesophageal fistula, who weigh over 1,800 gm and are without severe associated anomalies and/or pulmonary complications (Group A, B₁) and those of a higher birth weight with moderate pneumonia and a less severe congenital anomaly (Group B₂), can be reasonably expected to survive.