Andropoulos D B, Rowe R W, Betts J M
Department of Anesthesiology, Children's Hospital, Oakland, California 94609-1809, USA.
Paediatr Anaesth. 1998;8(4):313-9. doi: 10.1046/j.1460-9592.1998.00734.x.
A retrospective review of 61 cases of airway management for newborn tracheo-oesophageal fistula (TOF)/oesophageal atresia repair is presented. Standard management included induction of general anaesthesia and muscle relaxation before tracheal intubation, rigid bronchoscopy, careful placement of the tracheal tube below the TOF if possible, and occlusion of the fistula with a Fogarty embolectomy catheter in certain high risk cases. Gastrostomy was not routinely performed. Ventilation proceeded without difficulty in 48 cases. Ventilation difficulties were encountered in 13 cases. Eight of the 13 cases had large TOF, and four had other causes of difficult ventilation not related to the fistula. No patient with a small TOF had ventilation problems because of the TOF. Three patients had a large TOF successfully occluded with an embolectomy catheter through the bronchoscope. There were no complications ascribed to this technique. An algorithm is suggested for anaesthetic-surgical airway management in these cases.
本文对61例新生儿气管食管瘘（TOF）/食管闭锁修复术的气道管理进行了回顾性研究。标准管理包括在气管插管前诱导全身麻醉和肌肉松弛、硬质支气管镜检查、尽可能将气管导管小心放置在TOF下方，以及在某些高危病例中用Fogarty取栓导管封堵瘘管。胃造口术并非常规进行。48例通气顺利。13例出现通气困难。13例中有8例有较大的TOF，4例有与瘘管无关的其他通气困难原因。没有小TOF患者因TOF出现通气问题。3例大TOF患者通过支气管镜用取栓导管成功封堵。该技术未出现并发症。本文提出了这些病例麻醉-手术气道管理的算法。
