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PEDIATRIC ANESTHESIA

Successful Thoracoscopic Repair of Esophageal Atresia with Tracheoesophageal Fistula in a Newborn with Single Ventricle Physiology

Edward R. Mariano, MD^*, Larry F. Chu, MD, MS, Craig T. Albanese, MD, and Chandra Ramamoorthy, MBBS

*Department of Anesthesia, University of California at San Diego School of Medicine, San Diego, California; Department of Anesthesia, Department of Surgery, Division of Pediatric Surgery, Department of Anesthesia, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford, California

Address correspondence and reprint requests to Edward R. Mariano, MD, Department of Anesthesia, University of California at San Diego Medical Center, 200 West Arbor Drive, San Diego, CA 92103–8770. Address e-mail to ermariano{at}ucsd.edu.

A neonate with VACTERL association including tricuspid atresia was scheduled for thoracoscopic esophageal atresia with tracheoesophageal fistula (EA/TEF) repair and laparoscopic gastrostomy tube placement. In addition to standard noninvasive monitoring, arterial blood pressure, central venous pressure, and cerebral oxygen saturation were monitored. Gastric distension resulting from positive pressure ventilation prevented laparoscopic gastrostomy tube placement. Thoracoscopy with a CO₂ insufflation pressure of 6 mm Hg at low flow (1 L/min) was well tolerated hemodynamically despite hypercarbia and cerebral oxygen saturation was maintained. Careful monitoring and good communication were critical to the safe management of this single ventricle patient during thoracoscopic EA/TEF repair.