Anesthetic Management of a Preterm Neonate with Single Ventricle and VACTERL Association for Emergency Non-cardiac Surgery

Anesthetic management of neonates with congenital anomalies is complex, such as in vertebral, anal, cardiac, tracheo-esophageal, renal and limb (VACTERL) association, which is a constellation of birth defects involving many organ systems. In addition, preterm birth and small-for-gestational age pose a greater challenge to the perioperative course as compared to term neonates with appropriate birth weight. Perioperative management in these cases poses difficulty and requires a multi-disciplinary team approach, involving a neonatologist and pediatric cardiologist with a thorough pre- anesthetic evaluation, careful airway planning, and optimized hemodynamics. We report one such case of a preterm, small-for-gestational age neonate with single ventricle physiology, tracheo-esophageal fistula (TEF), duodenal atresia, and VACTERL association, posted for emergency TEF repair and laparotomy.