GASTRIC DISTENSION DURING ANESTHESIA IN A NEWBORN FOR SURGERY OF A TYPE-III ESOPHAGEAL ATRESIA REQUIRING A GASTROSTOMY

IPPV during anaesthesia for management of oesophageal atresia with tra cheo-oesophageal fistula (TOF) can cause gastric insufflation. We repo rt such a complication in a one-day-old newborn, who developed, 15 min after induction, a distension of the abdomen, hypoxia and bracdycardi a. An emergency gastrostomy was performed. His status improved rapidly and surgery could be completed. TOF was located at the carina and had a large calibre. To avoid gastric distension in such cases, the tip o f the tube is located just proximal to the carina, but distal to the f istula to prevent intubation of the latter. Difficulties are due to po sition of the fistula (carina, main bronchi) or its large bore. Gastri c distension carries a risk of regurgitation and inhalation of gastric contents, elevation of hemidiaphragm and lung compression, decreased tidal volume, decreased venous return, cardiovascular collapse and car diac arrest. When insufflation peak pressures are low, gastrostomy is benefitful, as in our case, as the tidal volume loss through the stoma ch is acceptable. In case of high insufflation pressures because of co -existing lung disease, gastrostomy is better avoided, as most if not all the tidal volume may be lost through the stomach. (C) 1998 Elsevie r, Paris.