Abstract
Tracheoesophageal Fistula (TEF), which is usually associated with Oesophageal Atresia (EA), is known to be a common congenital anomaly requiring urgent surgical intervention in the neonatal period. Anaesthetic management of TEF repair is very challenging because of the pathological communication between the airway and gastrointestinal tract, immature neonatal physiology, as well as frequent association with congenital anomalies, especially cardiac defects. Key aspects include the embryological basis, anatomical classification and pathophysiological implications influencing protection ventilation and airway, along with risk stratification using established prognostic systems such as the Spitz classification. Preoperative evaluation which is focused upon stabilisation strategies for minimising aspiration as well as respiratory compromise, detailed assessment for associated anomalies and optimisation of metabolic and respiratory status. Intraoperative management emphasises strategies into airway control inclusive of distal endotracheal tube placement, fibreoptic bronchoscopy-guided localisation of the fistula, lung-protective ventilation for reduction of gastric insufflation and barotrauma. Postoperative anaesthetic and critical care management including decisions regarding elective ventilation, analgesia, monitoring and the prevention of complications such as anastomotic leak and recurrent fistula are also reviewed. Advancements such as opioid-sparing multimodal analgesia, minimally invasive surgery techniques as well as protocol-based multidisciplinary care pathways have contributed further in improved perioperative outcomes. Despite such developments there are significant gaps also remains into high-quality evidence further guiding optimal ventilation strategies, extubation criteria, long-term outcomes. This narrative review article highlights current practices, recent advances, future directions into research for evidence-based anaesthetic management of TEF repair.