4th Pediatric Infectious Diseases Conference
 
 
Home  Back   ISSN 0973 - 0958
 
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Pedi Poll
Today's Poll
Should teicoplannin, colistin be used in case of neonatal sepsis where culture does not reveal any organism_?
No, it should be used only after drug sensitivity report
Yes, under guidance of an infectious disease expert
TRACHEO-OESOPHAGEAL FISTULA
TRACHEO-OESOPHAGEAL FISTULA
Dr Sunita Goel
Lecturer in Anaesthesiology
BJ Wadia Childrens hospital
PRE OPERATIVE MANAGEMENT
Oral feeds should be discontinued. Baby should be kept in semi upright position to minimise regurgitation. Proximal segment should be suctioned continuously to prevent aspiration. Severity of pulmonary disease should be evaluated. Hypothermia should be avoided.

GENERAL MANAGEMENT GENERAL MANAGEMENT
Sump catheter in upper pouch
Sump catheter in upper pouch
Upright positioning
Upright positioning
Screening for any congenital anomalies
Screening for any congenital anomalies
Correction of fluid electrolyte status
Correction of fluid electrolyte status
Gastrostomy, uncommon, usually in isolated EA
Gastrostomy, uncommon, usually in isolated EA

SURGICAL MANAGEMENT
Aim for one-stage repair
Aim for one-stage repair
Extrapleural approach
Extrapleural approach

  • Right thoracotomy
  • Division of fistula
  • Mobilisation and anastomosis
KIV Gastrostomy if anastomosis under tension
KIV Gastrostomy if anastomosis under tension

INTRA-OPERATIVE PROBLEMS
Lung retraction
Lung retraction
Secretions and blood clots
Secretions and blood clots
Kinking of trachea
Kinking of trachea

POST-OPERATIVE PROBLEMS
PROBLEMS
Tracheomalacia may result in life threatening cyanotic and apneic spells.
PROBLEMS
Tracheostomy may be necessary to maintain patent airway without ETT.
PROBLEMS
Leak
PROBLEMS
Stricture
PROBLEMS
Recurrent fistula
PROBLEMS
Problems with dysphagia and recurrent respiratory infections
PROBLEMS
Esophageal strictures might require dilatations
PROBLEMS
Abnormalities in esophageal motility leading to repeated aspirations.

Last created on 23-02-2001
Last updated on 11-05-2007


 
 
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