PENATALAKSANAAN PERIOPERATIF ATRESIA ESOFAGUS DENGAN FISTULA TRAKEOESOFAGEAL

Esophageal atresia with trachheoesophageal fistula occurs in 1 in 3,000 to 5,000 births. Esophageal atresia
is often associated with other congenital anomalies like ventricular septal defects, patent ductus arteriosus
or tetralogy of fallot.
We reported a neonatal patient with esophageal atresia. Surgery was performed 2 days after being treated
at the NICU. The operation lasted for 2 hours 25 minutes. The anesthetic technique is GA, semi open with
Jackson Reese, ETT number 3, controlled breathing. The premedication was 0.1 mg atropine sulphate and 5
μg fentanyl, induction and maintenance were sevoflurane and O2, and with 1mg atracurium muscle relaxant.
Postoperatively, patient was transported to the NICU in an intubated condition.
The problems of anesthesia management on patients with esophageal atresia are evaluation of aspiration
pneumonia, gastric overdistence, difficulty in ventilating the patient, the presence of other congenital
abnormalities, and postoperative intensive care. Early recognition, prevention of aspiration, and immediate
delivery to tertiary health care center will improve infant morbidity and mortality significantly.

Atresia esofagus dengan fistula trakeoesofageal terjadi pada 1 dari 3.000 sampai 5.000 kelahiran. Atresia
esofagus sering berhubungan dengan anomali kongenital lain seperti defek septum ventrikel, duktus arteriosus
paten atau tetralogy of fallot.
Dilaporkan pasien neonatus dengan atresia esofagus, dilakukan operasi setelah 2 hari dirawat di NICU.
Operasi berlangsung selama 2 jam 25 menit. Teknik anestesi yang digunakan adalah anestesi umum,
semi open dengan Jackson Reese, pipa endotrakeal ukuran 3.0, napas kendali. Premedikasi menggunakan
sulfas atropin 0,1 mg dan fentanyl 5 μg. Induksi dan maintenans anestesi menggunakan sevofluran dan O2,
dengan pelumpuh otot atracurium 1mg. Pascaoperasi pasien ditranspor ke NICU dalam keadaan terintubasi.
Masalah manajemen anestesi pada pasien dengan atresia esofagus adalah evaluasi adanya pneumonia
aspirasi, overdistensi lambung, kesulitan ventilasi, adanya kelainan kongenital lain yang menyertai, dan
perawatan intensif pascaoperasi. Pengenalan dini, pencegahan aspirasi, dan pengiriman segera ke pusat
pelayanan kesehatan tersier akan membantu perbaikan angka morbiditas dan mortalitas bayi secara
bermakna.