Background: Esophageal atresia (EA) with tracheoesophageal fistula is usually repaired in the neonatal period. Preferential ventilation through the fistula can lead to gastric distension. Bronchoscopy has a role in defining the site and size of the fistula, and may be carried out by the surgeon or the anesthetist. The use of bronchoscopy varies across different institutions.Methods: This is a multicenter case note review of infants with EA with tracheoesophageal fistula who underwent surgery between January 2010 and December 2015. This retrospective audit aims primarily to document the use of bronchoscopy during open and thoracoscopic repair at a selection of United Kingdom centers.Respiratory complications, that is relating to airway management, the respiratory system, and difficulty with ventilation, at induction and during surgery, are recorded.The range of techniques for anesthesia and analgesia in these centers is noted.Results: Bronchoscopy was carried out in 52% of cases. The incidence of respiratory complications was 7% at induction and 21% during surgery. Thoracoscopic repair usually took longer. One center used high-frequency oscillatory ventilation, on an elective basis during thoracoscopic repair, to facilitate surgical access and address concerns about hypoxemia and hypercarbia.
Conclusion: The use of bronchoscopy varies considerably between institutions.Infants undergoing tracheoesophageal fistula repair are at risk of perioperative respiratory morbidity. The advent of thoracoscopic repair has introduced further variation. K E Y W O R D S anesthesia, bronchoscopy, esophageal atresia, newborn, thoracoscopy, thoracotomy, tracheoesophageal fistula | 641 AHMAD et Al. How to cite this article: Ahmad NS, Dobby N, Walker E, et al. A multicenter audit of the use of bronchoscopy during open and thoracoscopic repair of esophageal atresia with tracheoesophageal fistula. Pediatr Anesth. 2019;29:640-647.
The Food and Drug Administration does not require surgical sutures to be tracked by manufacturer, physician, or patient; thereby, surgical sutures have been of little use to forensic practitioners who are tasked with establishing a positive identification with biological evidence. This study demonstrates the investigative process used to pinpoint suture manufacturers by presenting a case where surgical sutures were a distinctive characteristic that aided in the positive identification of skeletal remains. The suture's manufacturer, construction material and structure, size, and medical use was determined by contacting a local surgical suture and orthopedic implant manufacturer and utilizing publicly available manufacturer websites, which provide catalogs and specific product details. This research was one of many lines of evidence used to establish the positive identification of a 47-year-old male.
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