Outcome of patients operated on for esophageal atresia: 30 years' experience.

PURPOSE: The aim of this study was to evaluate the outcome and late sequelae of patients with esophageal atresia or tracheoesophageal fistula. METHODS: Sixty patients with esophageal atresia or tracheoesophageal fistula (EA-TEF) were treated in Tampere University Hospital in the years 1963 through 1993. Long-term outcome was evaluated with a questionnaire, pulmonary and esophageal function test results, 24-hour pH level monitoring, tracheobronchoscopy findings, and esophagogastroscopy with biopsy sections and samples for bacterial cultures. RESULTS: One third of the respondents reported having impaired quality of life because of respiratory infections, dyspnea, and difficulties in swallowing and coughing at night. Eighteen percent had gastroesophageal reflux (GER) symptoms. The rate of symptoms decreased with age. Impaired pulmonary function, GER, abnormal esophageal peristalsis, and transit time were registered. Tracheobronchoscopy showed tracheal narrowing and inflammation in one third; in histopathologic analysis, however, the rate of inflammation was more than doubled. Histologically, esophageal inflammation was found in 51%, Barrett's esophagus in 6%, and a Helicobacter pylori infection in 21% of cases. The severity of GER, esophageal peristaltic abnormality, tracheal inflammation, and impairment of pulmonary function seems to be alleviated with age. CONCLUSIONS: Although the long-term outcome of EA-TEF patients seems to be favorable, respiratory and gastrointestinal symptoms as well as functional abnormalities remain frequent. Gastric metaplasia in the esophagus and the high rate of tracheal, esophageal, and gastric inflammation indicate a need for long-term follow-up.

End-tidal oxygen concentration and pulse oximetry for monitoring oxygenation during intratracheal jet ventilation.

OBJECTIVE: In this study, we evaluated the usefulness of end-tidal oxygen monitoring during intratracheal jet ventilation (ITJV) for endolaryngeal laser surgery. METHODS: A total of 20 consecutive patients of both genders scheduled for endolaryngeal procedures under general anesthesia were studied. Inspiratory oxygen concentration and respiratory rate were varied, with patients serving as their own controls. Readings of pulse oximetry, airway oxygen, and carbon dioxide concentrations were recorded, and arterial blood samples for blood gas analysis were taken. RESULTS: At jet cycle rates of 20 cycles/min, end-tidal oxygen (ETO2) concentration indicated alveolar hypoxia 30 to 60 sec before hypoxemia was detected by pulse oximetry. Jet mixing of inspiratory and expiratory gas caused a larger difference between end-tidal and arterial gas concentrations than normally seen with conventional ventilation. Correlations between ETO2 concentrations, oxygen saturations, and arterial oxygen levels depended on respiratory rate and inspiratory oxygen concentration; correlations were stronger at low than at high inspiratory oxygen concentrations and stronger at low than at high respiratory rates. CONCLUSIONS: ETO2 concentration should be maintained well over 21% during ITJV to prevent alveolar and arterial hypoxia. Monitoring of respiratory oxygen concentrations at jet cycle rates of 20 cycles/min and less verifies safe oxygen levels during laser surgery, and confirms adequate alveolar oxygenation.