PDF(996 KB)
Effect of muscle relaxants on the prognosis of neonates with congenital esophageal atresia-tracheoesophageal fistula after surgery
HE Wen-Wen, WENG Jing-Wen, DONG Shi-Xiao, JIN Fei, WU Hai-Lan, HEI Ming-Yan
Chinese Journal of Contemporary Pediatrics ›› 2021, Vol. 23 ›› Issue (7) : 735-738.
PDF(996 KB)
PDF(996 KB)
Effect of muscle relaxants on the prognosis of neonates with congenital esophageal atresia-tracheoesophageal fistula after surgery
Objective To summarize the experience in the application of muscle relaxants in the perioperative period in neonates with congenital esophageal atresia-tracheoesophageal fistula (EA-TEF). Methods A retrospective analysis was performed on the medical data of 58 previously untreated neonates with EA-TEF who were treated in the Neonatal Center of Beijing Children's Hospital, Capital Medical University from 2017 to 2019. The incidence rate of anastomotic leak was compared between the neonates receiving muscle relaxants for different durations after surgery (≤ 5 days and > 5 days). The correlation between the duration of postoperative use of muscle relaxants and the duration of mechanical ventilation was evaluated. Results Among the 58 neonates with EA-TEF, 44 underwent surgery, among whom 35 with type III EA-TEF underwent thoracoscopic surgery. Among these 35 neonates, 30 (86%) received muscle relaxants after surgery, with a median duration of 4.75 days, and 6 (18%) experienced anastomotic leak. There was no significant difference in the incidence rate of anastomosis leak between the ≤ 5 days and > 5 days groups (P > 0.05). The duration of postoperative invasive mechanical ventilation was positively correlated with the duration of the use of muscle relaxants (rs=0.548, P < 0.05). Conclusions Prolonged use of muscle relaxants after surgery cannot significantly reduce the incidence of anastomotic leak, but can prolong the duration of invasive mechanical ventilation in neonates with EA-TEF. Therefore, prolonged use of muscle relaxants is not recommended after surgery.
Esophageal atresia-tracheoesophageal fistula / Muscle relaxant / Neonate
[1] Pedersen RN, Calzolari E, Husby S, et al. Oesophageal atresia:prevalence, prenatal diagnosis and associated anomalies in 23 European regions[J]. Arch Dis Child, 2012, 97(3):227-232. DOI:10.1136/archdischild-2011-300597. PMID:22247246.
[2] Pini Prato A, Carlucci M, Bagolan P, et al. A cross-sectional nationwide survey on esophageal atresia and tracheoesophageal fistula[J]. J Pediatr Surg, 2015, 50(9):1441-1456. DOI:10.1016/j.jpedsurg.2015.01.004. PMID:25783403.
[3] Zhou Y, Mao XQ, Zhou H, et al. Epidemiology of birth defects based on a birth defect surveillance system in Southern Jiangsu, China, 2014-2018[J]. J Matern Fetal Neonatal Med, 2020. DOI:10.1080/14767058.2020.1731459. PMID:32098533. Epub ahead of print.
[4] Smith N. Oesophageal atresia and tracheo-oesophageal fistula[J]. Early Hum Dev, 2014, 90(12):947-950. DOI:10.1016/j.earlhumdev.2014.09.012. PMID:25448787.
[5] Lal DR, Gadepalli SK, Downard CD, et al. Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula[J]. J Pediatr Surg, 2017, 52(8):1245-1251. DOI:10.1016/j.jpedsurg.2016.11.046. PMID:27993359.
[6] Bagolan P, Iacobelli Bd Bd, De Angelis P, et al. Long gap esophageal atresia and esophageal replacement:moving toward a separation?[J]. J Pediatr Surg, 2004, 39(7):1084-1090. DOI:10.1016/j.jpedsurg.2004.03.048. PMID:15213904.
[7] 冯翠竹, 马继东, 董宁, 等. 胸腔镜与开胸手术治疗先天性食管闭锁并食管气管瘘的对比研究[J]. 中华小儿外科杂志, 2016, 37(8):589-592. DOI:10.3760/cma.j.issn.0253-3006.2016.08.007. PMID:30704229. PMCID:PMC7351698.
[8] Sadreameli SC, McGrath-Morrow SA. Respiratory care of infants and children with congenital tracheo-oesophageal fistula and oesophageal atresia[J]. Paediatr Respir Rev, 2016, 17:16-23. DOI:10.1016/j.prrv.2015.02.005. PMID:25800226. PMCID:PMC4559488.
[9] Baird R, Lal DR, Ricca RL, et al. Management of long gap esophageal atresia:a systematic review and evidence-based guidelines from the APSA Outcomes and Evidence Based Practice Committee[J]. J Pediatr Surg, 2019, 54(4):675-687. DOI:10.1016/j.jpedsurg.2018.12.019. PMID:30853248.
[10] Okata Y, Maeda K, Bitoh Y, et al. Evaluation of the intraoperative risk factors for esophageal anastomotic complications after primary repair of esophageal atresia with tracheoesophageal fistula[J]. Pediatr Surg Int, 2016, 32(9):869-873. DOI:10.1007/s00383-016-3931-0. PMID:27461430.
[11] Dingemann C, Eaton S, Aksnes G, et al. ERNICA consensus conference on the management of patients with esophageal atresia and tracheoesophageal fistula:diagnostics, preoperative, operative, and postoperative management[J]. Eur J Pediatr Surg, 2020, 30(4):326-336. DOI:10.1055/s-0039-1693116. PMID:31266084.
