Thoracic Segmental Spinal Anesthesia In Pediatric Patient With Esophageal Atresia With Ventricular Septal Defect And Mild Pulmonary Hypertension Posted For Esophagostomy And Gastrostomy

Abstract

Introduction

Esophageal atresia (EA) is congenital anomaly commonly found with trachea-esophageal fistula of neonate in 1st week of life. This anomaly can cause several complications including aspiration, reduction in respiration, and complication from concomitant congenital anomalies, mostly from cardiac origin. Thoracic segmental spinal is typically used for patient undergoing surgery with major medical problems which improved patient’s safety, reduced post anesthesia care stays and better postoperative pain relief.
Case Report

A case of 2 days old male,2.2 kg weight, presented at UNM children hospital with chief complaint of inability of pass Nasogastric tube beyond 8-10 cm after birth with drooling of saliva. Preoperatively anesthetic checkup was done which revealed moderate ventricular septal defect with mild Pulmonary hypertension on 2d echo. We proposed thoracic segmental spinal anesthesia with small dose of isobaric levobupivacaine.
Patient was given premedication of Inj. Ketamine (1mg/kg) and Inj. Dexmedetomidine (0.4 microgram/kg). Under aseptic precaution thoracis segmental spinal anesthesia was given with inj isobaric levobupivacaine in the dose of 0.02 mg/kg. Intraoperatively Injection Dextrose 1% in Inj. Ringer lactate given. O2 was given via facemask and patient was hemodynamically stable throughout the surgery and postoperatively.
Conclusion:

Neonate with EA and TEF can cause problems and challenges for Anesthesiologist. By using thoracic segmental spinal anesthesia proves a better modality for such a syndromic child which avoid unnecessary intubation, postoperative complication related to general anesthesia, avoid postoperative ventilation and provide post-operative better analgesia.