Sudden and Severe Hypoxia During Anesthesia Induction for A Neonatal Esophageal Atresia: Consider Accidental Esophageal Fistula Intubation

A full-term neonate with type C esophageal atresia was scheduled in an emergency for surgical repair. During induction of anesthesia, the TEF was identified by a flexible tracheobronchoscopy. After endotracheal tube cuffed (ETT) insertion, ventilation was immediately impossible and led to severe hypoxia, requiring resuscitation maneuvers and an emergency percutaneous gastrostomy. The diagnosis of TEF intubation was made after ruling out the other typical causes of non-ventilation, such esophageal intubation, bronchospasm, hypovolemia, pneumothorax, obstructive secretions in ETT. After effective tracheal reintubation, the surgery proceeded normally. We did not observe any long-term sequelae. TEF intubation during EA is a rare and poorly described event. We want to highlight this risk and the importance of having a multidisciplinary medical team present during anesthesia induction for neonatal EA surgical repair. To ensure optimal placement of ETT, this team should be able to perform real-time tracheal endoscopy, chest X-ray, or ultrasound.