A Novel Intervention for Refractory Bradycardia and Desaturation in a Neonate Undergoing Tracheoesophageal Repair Under General Anesthesia

A 3-day-old preterm neonate, with esophageal atresia and tracheoesophageal fistula (TEF) type C, American Society of Anesthesiologists grade 3, was posted for a right thoracotomy, ligation of fistula, and end-to-end anastomosis of esophagus under general anesthesia. Following induction, recurrent bradycardia and desaturation occurred during fistula ligation unresponsive to injection atropine, fluid boluses, release of lung retractor, and intermittent bilateral lung inflation. A decision to transiently block the cardiac vagal fibers through the surgical site stabilized the vitals allowing the surgery to proceed uneventfully. This case highlights the challenges faced by the anesthesiologist while managing neonates with TEF in the peri-operative period owing to associated VACTREL anomalies, vascular access, airway management, risk of hypothermia, and immature hemodynamic response that could lead to arrhythmias and cardiac arrest.