TE fistula: ETT positioning
In regards to airway management in TEF, one of the foremost concerns is the avoidance of ventilation through the fistula with resultant gastric distention and inadequate pulmonary ventilation. A hallmark in the airway management of these patients is to maintain spontaneous ventilation until the fistula tract is ligated. A variety of techniques have been described to minimize this complication. The conservative approach involves an awake intubation to avoid positive pressure mask ventilation. Alternatively, some practitioners have employed an inhalation induction of anesthesia with spontaneous ventilation and gentle positive pressure ventilation as needed (Knottenbelt, 2012).