Accidental esophageal intubation via a large type C congenital tracheoesophageal fistula:A case report  

作　　者：Seong Min Hwang Myeong Jin Kim Sora Kim Saeyoung Kim 

机构地区：[1]Department of Anesthesiology and Pain Medicine,School of Medicine,Kyungpook National University,Daegu 41944,South Korea

出　　处：《World Journal of Clinical Cases》2022年第30期11198-11203,共6页世界临床病例杂志

摘　　要：BACKGROUND Tracheoesophageal fistula(TEF)is a congenital anomaly characterized by interruptions in esophageal continuity with or without fistulous communication to the trachea.Anesthetic management during TEF repair is challenging because of the difficulty of perioperative airway management.It is important to determine the appropriate position of the endotracheal tube(ETT)for proper ventilation and to prevent excessive gastric dilatation.Therefore,the tip of the ETT should be placed immediately below the fistula and above the carina.CASE SUMMARY A full-term,one-day-old,2.4 kg,50 cm male neonate was diagnosed with TEF type C.During induction,an ETT was inserted using video laryngoscope and advanced deeply to ensure that the tip passed over the fistula,according to known strategies.The passage of the ETT through the vocal cords was confirmed via video laryngoscope.However,after inflating the ETT cuff,breath sounds were not heard on bilateral lung auscultation.Instead,gastric sounds were heard.Considering that a large fistula(approximately 6.60 mm×4.54 mm)located 10.2mm above the carina was confirmed on preoperative tracheal computed tomography,the possibility of unintentional esophageal intubation was highly suspected.Therefore,we decided to uncuff and withdraw the ETT carefully for repositioning,while monitoring auscultation and end-tidal CO2 simultaneously.At a certain point(9.5 cm from the lip),clear breath sounds and proper end-tidal CO_(2) readings were suddenly achieved,and adequate ventilation was possible.CONCLUSION Preanesthetic anatomical evaluation with imaging studies in TEF is necessary to minimize complications related to airway management.

关 键 词：Tracheoesophageal fistula Imaging study Anatomy INTUBATION Airway management AUSCULTATION Case report 

分 类 号：R562.13[医药卫生—呼吸系统]