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The insertion of an endotracheal tube (ETT) in a patient of esophageal atresia (EA) with tracheaesophageal fistula (TEF) can be challenging for even the most experienced of anesthesiologist. Incorrect placement, if not detected on time, can have the most devastating complications. The correct placement of an endotracheal tube is dependent on the anatomy and morphology of the fistula. Holzki et al [1] in their study of bronchoscopy on 113 patients of EA with TEF reported that in 11% of patients, the fistula was below the level of carina, in 22% the fistula was within 1cm of the carina while in 67% the fistula was 1cm above the carina. Furthermore, these patients sometimes have other associated congenital anomalies such as tracheomalacia and vascular ring that require additional intervention.

Endotracheal Intubation in a Neonate with Esophageal Atresia and Trachea-Esophageal Fistula: Pitfalls and Techniques