Case Report
 
A challenging anesthetic management of acquired tracheo-esophageal fistula operation
Hija Yazıcıoğlu1, Bilfer Özler2, Büşra Tezcan2, Mahmut Subaşı3, Erdal Yekeler4
1Associate Prof. University of Medical Sciences, Turkey Yuksek Ihtisas Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
2Specialist, University of Medical Sciences, Turkey Yuksek Ihtisas Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
3Specialist Surgeon, University of Medical Sciences Turkey Yuksek Ihtisas Hospital, Thoracic Surgery and Lung Transplantation Department, Ankara, Turkey
4Associate Prof. Surgeon, University of Medical Sciences Turkey Yuksek Ihtisas Hospital, Thoracic Surgery and Lung Transplantation Department, Ankara, Turkey

Article ID: 100932Z01HY2018
doi: 10.5348/100932Z01HY2018CR

Corresponding Author:
Hija Yazıcıoğlu
Bilkent 2, Park Sitesi
G-4 Blok No: 22/ 32
Bilkent Çankaya 06800, Ankara Turkey

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How to cite this article
Yazıcıoğlu H, Özler B, Tezcan B, Subaşı M, Yekeler E. A challenging anesthetic management of acquired tracheo-Esophageal fistula operation. Int J Case Rep Images 2018;9:100932Z01HY2018.


ABSTRACT

Tracheo-esophageal fistula (TEF) is a rare but highly morbid complication of tracheal stent. In this case report we presented a challenging anesthetic management of TEF repair. An 18-year-old female patient with epilepsy diagnosis was intubated during epileptic seizure. Tracheomalasia occurred rapidly and stent placement was done inevitably. However TEF developed, rigid bronchoscopy was planned for the removal of the stent. Following premedication induction of anesthesia was done with fentanyl, lidocaine, propofol and rocuronium and maintained with propofol-remifentanil. She was ventilated manually with high flow and high fraction of inspired oxygen (FiO₂). Tracheal resection and primer esophagus repair was considered after failed stent removal attempts. She was intubated with 5.5 no cuffed endotracheal intubation tube (ETT), ventilated with pressure controlled ventilation (PCV) mode. An ETT was placed into the distal trachea when trachea was resected. High flow, 100% O2 for three minutes was applied manually before apneic periods necessary for the operation. Following esophagus repair before suturing trachea, an aspiration probe was advanced retrogradely from the proximal end of the tracheal incision into the mouth and she was intubated orally via this probe. Depth of anesthesia was assessed with Sedline® (Masimo, USA) monitor. There was no significant hypoxemia, hypercarbia and hemodynamic instability during the whole procedure. Her neck position was extremely flexed during transport and in the ICU. She was extubated on the 12th hour. Anesthesia during TEF repair includes challenges in difficult intubation, sharing airway with the surgical team, troubles during apnea periods, air leakage during ventilation, providing deep anesthesia. Anesthesia management is a challenge but enhances the knowledge and practice of the anesthetist.

Keywords: Airway management, Anesthesia, Tracheo-esophageal fistula


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Author Contributions
Hija Yazıcıoğlu – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Bilfer Özler – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Büşra Tezcan – Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Mahmut Subaşı – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Erdal Yekeler – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of Submission
The corresponding author is the guarantor of submission.
Source of Support
None
Consent Statement
Written informed consent was obtained from the patient for publication of this case report.
Conflict of Interest
Author declares no conflict of interest.
Copyright
© 2018 Hija Yazıcıoğlu et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.