1/14. anesthesia for insertion of a Dumon stent in a patient with a large tracheo-esophageal fistula.PURPOSE: To present the anesthetic management for the insertion of a Dumon silicon stent to the trachea of a patient with a large tracheo-esophageal fistula. The aim of the stent insertion was to seal the fistula in order to prevent aspiration of esophageal content and subsequent pneumonitis. CLINICAL FEATURES: A 45-yr-old man with a large tracheo-esophageal fistula was scheduled for the insertion of the Dumon stent. Since placement of the stent necessitates the insertion of a rigid bronchoscope, under general anesthesia, with its tip just proximal to the fistula, controlled ventilation was expected to be difficult to achieve because of the diversion of oxygen through the large fistula to the esophagus. We successfully ventilated the lungs, after the fistula was sealed using a large balloon which was inserted in the esophagus, and the stent insertion was completed uneventfully. CONCLUSION: anesthesia for procedures involving the central airway is challenging. This report describes a simple and practical method to facilitate ventilation by temporary seal of a tracheo-esophageal fistula using a modified esophageal balloon.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
2/14. Silicone airway stent for treating benign tracheoesophageal fistula.We used a silicone tracheal stent successfully to seal a huge benign tracheoesophageal fistula and restore airway patency after treatment with double metallic stenting of the trachea and esophagus failed. The patient was weaned from the ventilator 16 days after the procedure and after 7 months of ventilatory support.- - - - - - - - - - ranking = 0.33333333333333keywords = seal (Clic here for more details about this article) |
3/14. Use of high-frequency jet ventilation in the management of congenital tracheoesophageal fistula associated with respiratory distress syndrome.Two preterm infants (28 weeks, 960 g; 32 weeks, 1,870 g) with very large tracheoesophageal fistulas suffered from respiratory distress syndrome and failed to respond to conventional mechanical ventilation despite placement of a decompressive gastrostomy. Pulmonary air leaks developed in both, resulting in transdiaphragmatic pneumoperitoneum, and significant gas flow occurred through the gastrostomy tube despite placement under water-seal. high-frequency jet ventilation was instituted in each case and resulted in improved pulmonary gas exchange at lower mean airway pressure (12.0 to 6.7 cm H2O; 11.0 to 8.0 cm H2O) and in prompt resolution of air leaks. Both patients remained refractory to reinstitution of conventional ventilation until division of the fistula in the first patient and complete resolution of the respiratory distress syndrome in the second.- - - - - - - - - - ranking = 0.33333333333333keywords = seal (Clic here for more details about this article) |
4/14. "Waterseal" gastrostomy in the management of premature infants with tracheoesophageal fistula and pulmonary insufficiency.The perioperative management of premature infants with esophageal atresia and tracheoesophageal fistula (EA/TEF) complicated by pulmonary insufficiency continues to be a challenge. Definitive repair is usually delayed or staged and a gastrostomy is initially placed to prevent reflux aspiration. In patients with decreased pulmonary compliance, gastrostomy placement results in decreased intragastric pressure leading to a loss of ventilatory pressure via the tracheoesophageal fistula. A technique using the principle of underwater seal to maintain effective ventilatory pressure after gastrostomy placement is described, and two illustrative cases are presented. After acute respiratory decompensation in these patients, the gastrostomy tube was connected to underwater seal resulting in improved respiratory status. The underwater seal is allowed to intermittently "bubble," thereby permitting partial gastric decompression. This technique maintains effective ventilatory pressure after gastrostomy placement in premature infants with EA/TEF and pulmonary insufficiency until definitive therapy can be achieved.- - - - - - - - - - ranking = 2.3333333333333keywords = seal (Clic here for more details about this article) |
5/14. Improved palliation of a respiratory-esophageal fistula with a cuffed esophageal prosthesis.We report a case in which a traditional prosthesis failed to seal a malignant respiratory-esophageal fistula. Removal of the prosthesis and replacement with a new type with an inflatable cuff provided palliation, and allowed the patient to leave the hospital. The cuffed prosthesis provides a custom fit which should seal fistulous tracts of any shape or size, without causing tissue necrosis.- - - - - - - - - - ranking = 0.66666666666667keywords = seal (Clic here for more details about this article) |
6/14. A cuffed tube for the treatment of oesophago-bronchial fistulae.An oesophageal tube provided with a foam-rubber cuff is described. The outside diameter of the cuff can be diminished while the tube is being introduced. After implantation, the expanded foam-rubber cuff achieves additional sealing of the oesophago-bronchial fistula. The tube described is suitable for sealing off oesophago-bronchial fistulae in the absence of the tumour-induced stenosis of the oesophagus.- - - - - - - - - - ranking = 0.66666666666667keywords = seal (Clic here for more details about this article) |
7/14. The use of pericardium for the management of recurrent tracheoesophageal fistula.Correction of congenital esophageal atresia and tracheoesophageal fistula (TEF) with either a primary or staged repair may result in recurrence of the TEF, most often at the site of esophageal anastomosis. Definitive operative repair of a recurrent TEF involves isolation and resection of the fistula with closure of the tracheal and esophageal defects. A technique is described, whereby mobilization of a vascularized pedicle of pericardium allows further enhancement of the standard repair of a recurrent TEF. The vascularized pedicle of pericardium serves to isolate the tracheal and esophageal suture lines from each other, as well as aid in sealing leaks at either or both suture lines. This may dramatically reduce the incidence of second recurrences and lower the overall operative mortality, reportedly as high as 59%.- - - - - - - - - - ranking = 0.33333333333333keywords = seal (Clic here for more details about this article) |
8/14. Endoscopic closure of recurrent tracheoesophageal fistula using Tisseel.The author reports on two patients who presented with recurrent tracheoesophageal fistula. They were treated with the endoscopic application of fibrin sealant (Tisseel) directly to the fistula tract. The technique may require multiple applications before complete fistula closure is achieved. The procedure is associated with low morbidity and may eliminate the need for a second thoracotomy.- - - - - - - - - - ranking = 0.33333333333333keywords = seal (Clic here for more details about this article) |
9/14. Tracheal stenting for malignant tracheoesophageal fistula.Palliative intubation of the esophagus for a malignant tracheoesophageal fistula is often complicated by difficulty in obtaining a tight seal. We have overcome the problem in three instances by placing a bifurcated, foam-cuffed stent in the trachea.- - - - - - - - - - ranking = 0.33333333333333keywords = seal (Clic here for more details about this article) |
10/14. Bifurcate tracheal stent with foam cuff for tracheo-esophageal fistula: utilization of reconstruction modes of spiral computed tomography.Malignant tracheo-esophageal fistulae can be palliated with bifurcate tracheal stents. However, stents must be manufactured according to the individual anatomy. In these instances a foam cuff can result in better sealing of the fistulized area. We present a successful implantation of a bifurcate tracheal stent with foam cuff. To facilitate preoperative planning reconstruction possibilities offered by spiral computed tomography were used.- - - - - - - - - - ranking = 0.33333333333333keywords = seal (Clic here for more details about this article) |
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