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Management of Low Tidal Volume and ETCO2 during Thoracoscopy in the Treatment of Tracheo-Esophageal Fistula: A Case Report

Yi Zhao and Xiangdong Chen

Esophageal atresia with tracheo-oesophageal fistula (TEF) occurs in 1 in 2500-3000 live births. Management of airway and ventilation in TEF repair is challenging. Nowadays, advances in minimally invasive surgical techniques and neonatal intensive care for neonates have allowed endoscopically repair of TEF, which lends another level of complexity to airway management. Usually, a sudden increase in ETCO₂ should alert the anesthesiologist to possible surgical trauma and entrainment of thoracoscopic gas. However, low ETCO₂ emerging with low tidal volume can also alerts the anesthesiologist to possible surgical trauma. We had an uncommon situation, where a sudden low ETCO₂ emerged with low tidal volume when doing the complete anastomosis. After communicating with surgeons, they stopped and tried to find the possible causes. Finally, it appeared to be a surgical injury on the right lung. Continuous communication between the surgeon and the anesthesiologist is imperative when performing these operations.