RESUMO
La atresia de esófago es una malformación infrecuente (1:2.500-4.500 recién nacidos vivos), incompatible con la vida y una urgencia quirúrgica neonatal. El 30% de los pacientes son prematuros o presentan bajo peso al nacer y el 50% presentan anomalías asociadas, principalmente cardíacas. Las cardiopatías congénitas de orden mayor o el bajo peso al nacer son predictores independientes de mortalidad y eventos críticos perioperatorios. Presentamos el caso de un paciente intervenido de urgencia de atresia de esófago, fístula traqueoesofágica tipo iii b/C e imperforación anal. El objetivo de este artículo es la exposición de las consideraciones anestésicas en pacientes con esta afección, cuyo complejo manejo perioperatorio supone un importante reto y debe realizarse por equipos multidisciplinares con experiencia en neonatología. Establecer una vía aérea segura y obtener una ventilación pulmonar efectiva que minimice la fuga de aire al tracto digestivo debe ser uno de los objetivos prioritarios del manejo anestésico (AU)
Esophageal atresia is a rare condition (1:2,500-4,500), incompatible with life, and a surgical emergency in the neonatal period. It is associated with prematurity in 30% of cases, and to congenital abnormalities in 50% of cases, especially cardiac anomalies. Major congenital heart diseases and low weight are independent predictors of mortality and critical perioperative events. The aim of this article is to describe the most significant anaesthetic challenges presented in a case of a term neonate undergoing emergency surgery after being diagnosed with esophageal atresia, tracheoesophageal fistula type iiib/C, and imperforate anus. The major priorities during the anaesthetic management consist of establishing a safe airway and effective pulmonary ventilation that minimises air leakage to the upper digestive tract (AU)
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Anus Imperfurado/tratamento farmacológico , Anus Imperfurado/cirurgia , Atresia Esofágica/complicações , Atresia Esofágica/tratamento farmacológico , Atresia Esofágica/cirurgia , Fístula/tratamento farmacológico , Fístula/cirurgia , Fístula Traqueoesofágica/tratamento farmacológico , Fístula Traqueoesofágica/fisiopatologia , Fístula Traqueoesofágica/cirurgia , Esôfago/anormalidades , Esôfago , Esôfago/cirurgia , Período Perioperatório/métodosRESUMO
Esophageal atresia is a rare condition (1:2,500-4,500), incompatible with life, and a surgical emergency in the neonatal period. It is associated with prematurity in 30% of cases, and to congenital abnormalities in 50% of cases, especially cardiac anomalies. Major congenital heart diseases and low weight are independent predictors of mortality and critical perioperative events. The aim of this article is to describe the most significant anaesthetic challenges presented in a case of a term neonate undergoing emergency surgery after being diagnosed with esophageal atresia, tracheoesophageal fistula type iiib/C, and imperforate anus. The major priorities during the anaesthetic management consist of establishing a safe airway and effective pulmonary ventilation that minimises air leakage to the upper digestive tract.
