Karamehmet YILDIZ, Özlem ÖZ GERGİN, Recep AKSU, Oğuz Kaan Şimşek, Ednan BAYRAM, Sibel SEÇKİN PEHLİVAN

Trakeoözofageal Fistül/Özofageal Atrezili Yenidoğanlarda Anestezi Deneyimimiz: 65 Olgunun Retrospektif Analizi

Amaç: Trakeoözofageal fistül (TÖF) ve özofagus atrezisi (ÖA) olan yenidoğanların takibi, doğdukları andan itibaren özel ilgi ve bakım gerektirir. Anestezistler bu hastaların perioperatif takiplerinde, çoğu anlık gelişen birçok sorunla mücadele etmek durumundadır. Özellikle hastaların prognozunu belirleyen vital ve metabolik para- metrelerin iyi yönetilmediği olgularda, komplikasyonlar ve morta- lite artmaktadır. Bu retrospektif çalışmada amacımız, kliniğimizde takip ve tedavisi gerçekleştirilen olgulardan perioperatif veri ka- yıtları yeterli olan 65 hastanın anestezi yönetimini ve elde edilen bulguları güncel literatür bulguları eşliğinde sunmaktır. Yöntem: Bu çalışmada, Erciyes Üniversitesi Tıp Fakültesi Çocuk Cerrahisi ameliyathanesinde 2010-2021 tarihleri arasında, ÖA ve TÖF cerrahisi uygulanan 65 hastanın perioperatif yönetimi, retros- pektif olarak incelenmiştir. Bulgular: Değerlendirilen 65 olgunun, 34’ü erkek, 31’i kız hastaydı. Ameliyata alınma zamanları, torakoskopik cerrahi uygulananlarda ortalama doğumdan sonraki 4. gün, açık cerrahi uygulananlarda ise 5. gün olarak tespit edildi. Kırk üç hastada kardiyak anomaliler mevcuttu. Cerrahi yaklaşım çoğunlukla (%72) torakotomiyle yapıl- dı. Torakoskopik cerrahi yapılan hastaların, yoğun bakımda entübe kalma ve yoğun bakımda takip süreleri ile hospitalizasyon süreleri daha kısaydı. Torakotomi ile opere olanlarda ise oral olarak bes- lenmeye torakoskopik cerrahi yapılanlara göre daha geç başlandığı tespit edildi. Sonuç: Çalışmamızda açık ve torakoskopik yöntemle cerrahi dü- zeltmeleri gerçekleştirilen olguların yer alması ve olguların ta- mamında kliniğimizde kabul gören kurumsal perioperatif anes- tezi protokolünün uygulanması, sonuçlarımızın güvenilirliğini artırmaktadır. Çalışmada, açık ya da torakoskopik yöntemle cerrahi düzeltme uygulanacak TÖF/ÖA hastalarının perioperatif anestezi yönetimi konusunda yazarların deneyimi sunulmuş, literatür bilgi- leri ile birlikte tartışılmıştır.

Our Experience of Anesthesia in Newborn with Tracheoesophageal Fistula/Esophageal Atresia: A Retrospective Analysis of 65 Cases

Objective: Follow-up of newborns with tracheoesophageal fistula (TEF) and esophageal atresia (EA) requires special attention and care from the moment they are born. Anesthesiologists have to deal with several problems, that may develop instantly, during perioperative management of these patients. Complications and mortality increase especially in cases where the vital and metabo- lic parameters that determine the prognosis of the patients are not well managed. In this retrospective study, our aim is to present the anesthesia management of 65 patients who were followed up and treated in our clinic, with sufficient perioperative data recor- ds, and the results obtained in the light of current literature. Methods: In this study, the perioperative management of 65 pa- tients who underwent EA and TEF surgery between 2010-2021 in the Erciyes University Faculty of Medicine Pediatric Surgery ope- rating room were retrospectively analyzed. Results: Of the 65 cases evaluated, 34 were male and 31 were female. The time of admission to surgery was determined as the 4th day after birth in those who underwent thoracoscopic surgery and the 5th day in those who underwent open surgery. Forty-three patients had cardiac anomalies. The surgical approach was usual- ly performed with thoracotomy (72%). Patients who underwent thoracoscopic surgery had shorter intubated and hospitalization times in the intensive care unit. In those who were operated with thoracotomy, oral feeding was started later than thoracoscopic surgery. Conclusion: The inclusion of cases with open and thoracoscopic surgical corrections in our study and the application of the ins- titutional anesthesia protocol accepted in our clinic in the peri- operative management of all cases increase the reliability of our results. In this study, the experience of the authors on periopera- tive anesthesia management of TEF/EA patients who will undergo surgical correction by open or thoracoscopic method is presented and discussed together with the literature information.

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