WikiAnesthesia - User contributions [en]

Repair of tracheoesophageal fistula (TEF)

2023-09-24T00:43:50Z

Agfasman: Added the summary table

{{Infobox surgical procedure
| anesthesia_type = General
| airway = ETT ± Spontaneous Ventilation, Mainstem Intubation, or Fogarty Catheter
| lines_access = PIV, Arterial Line
| monitors = Standard, 5-Lead ECG, Temperature, Pulse Oximeter, NIBP or ABP
| considerations_preoperative = Fistula Type, VACTERL Association
| considerations_intraoperative = PPV vs. NPV, Paralysis vs. No Paralysis, Tolerance of Thoracoscopic Insufflation
| considerations_postoperative = Transferring Care While Intubated
}}

Tracheoesophageal fistula (TEF) is a congenital anomaly seen in the neonatal period in which a patient's trachea and esophagus fail to septate properly. TEF occurs in approximately 1 in 3,000 live births<ref name=":0">{{Cite web|last=Morris|first=Michael|last2=Blewett|first2=Christopher|title=Tracheoesophageal Fistula|url=https://publications.aap.org/neoreviews/article/18/8/e472/91872/Tracheoesophageal-Fistula?autologincheck=redirected|url-status=live|access-date=2023-07-26|website=publications.aap.org|doi=10.1542/neo.18-8-e472}}</ref>. Prenatal ultrasound can show an absent gastric bubble and polyhydramnios. In the neonatal period, signs and symptoms of TEF include respiratory distress with feeding, regurgitation, and choking. Diagnosis is confirmed by failing to pass an orogastric tube, with radiography showing tube coiling in the upper airway, increased gastric and intestinal air, and possible pneumonitis<ref name=":1">{{Cite journal|last=Slater|first=Bethany J.|last2=Rothenberg|first2=Steven S.|date=2016-06|title=Tracheoesophageal fistula|url=https://pubmed.ncbi.nlm.nih.gov/27301604|journal=Seminars in Pediatric Surgery|volume=25|issue=3|pages=176–178|doi=10.1053/j.sempedsurg.2016.02.010|issn=1532-9453|pmid=27301604}}</ref>. Surgical repair is the only definitive therapy. Anesthesia concerns are primarily related to airway management.

== Overview ==

=== Fistula Types ===
TEF comes in five different anatomical configurations. The most common is a "Type C" fistula, seen in ~85% of patients, consisting of proximal esophageal atresia with a fistula between the trachea and the distal esophageal segment<ref>{{Cite journal|last=Lee|first=Sura|date=2018-02|title=Basic Knowledge of Tracheoesophageal Fistula and Esophageal Atresia|url=https://pubmed.ncbi.nlm.nih.gov/29373345|journal=Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses|volume=18|issue=1|pages=14–21|doi=10.1097/ANC.0000000000000464|issn=1536-0911|pmid=29373345}}</ref>. Other configurations include:

Type A: Esophageal atresia without any fistula connection between the trachea and esophagus.

Type B: Esophageal atresia with a fistula between the trachea and the proximal esophageal segment.

Type D: Esophageal atresia with two fistulae– one between the trachea and the proximal esophageal segment, and one between the trachea and the distal esophageal segment.

Type E: Fistula between the trachea and esophagus without esophageal atresia (also called an "H-Type Fistula").

The position of the fistula can have a significant impact on airway management.

=== VACTREL Association<ref name=":2">{{Cite journal|last=Solomon|first=Benjamin D.|last2=Baker|first2=Linda A.|last3=Bear|first3=Kelly A.|last4=Cunningham|first4=Bridget K.|last5=Giampietro|first5=Philip F.|last6=Hadigan|first6=Colleen|last7=Hadley|first7=Donald W.|last8=Harrison|first8=Steven|last9=Levitt|first9=Marc A.|last10=Niforatos|first10=Nickie|last11=Paul|first11=Scott M.|date=2014-03|title=An approach to the identification of anomalies and etiologies in neonates with identified or suspected VACTERL (vertebral defects, anal atresia, tracheo-esophageal fistula with esophageal atresia, cardiac anomalies, renal anomalies, and limb anomalies) association|url=https://pubmed.ncbi.nlm.nih.gov/24332453|journal=The Journal of Pediatrics|volume=164|issue=3|pages=451–457.e1|doi=10.1016/j.jpeds.2013.10.086|issn=1097-6833|pmc=3943871|pmid=24332453}}</ref> ===
When TEF is diagnosed, workup must also be initiated for associated congenital anomalies referred to as the "VACTERL" Association. Diagnosis requires the presence of at least two of the following conditions: Vertebral anomalies (seen in 60%-90% of VACTERL diagnoses), Anorectal malformations (55%-90%), Cardiac anomalies (40%-80%), TEF (50%-80%), Renal anomalies (50%-80%), and Limb anomalies (40%-55%). Presence or absence of cardiac anomalies, including cyanotic congenital heart defects, situs inversus, vascular anomalies or arrhythmias, has the biggest impact on overall survival and anesthetic management<ref>{{Cite journal|last=Spitz|first=Lewis|date=2007-05-11|title=Oesophageal atresia|url=https://pubmed.ncbi.nlm.nih.gov/17498283|journal=Orphanet Journal of Rare Diseases|volume=2|pages=24|doi=10.1186/1750-1172-2-24|issn=1750-1172|pmc=1884133|pmid=17498283}}</ref>.

=== Surgical procedure ===
Surgery can be performed via an open or thoracoscopic approach. Thoracoscopy avoids many of the complications of the open approach, such as development of scoliosis or shoulder glide weakness<ref>{{Cite journal|last=Rothenberg|first=S. S.|date=2013-05|title=Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula in neonates, first decade's experience: Thoracoscopic repair of EATEF|url=https://academic.oup.com/dote/article-lookup/doi/10.1111/dote.12054|journal=Diseases of the Esophagus|language=en|volume=26|issue=4|pages=359–364|doi=10.1111/dote.12054}}</ref>. Thoracoscopy has also been associated with longer operating times, but shorter time to extubation and shorter time to first enteral feeding, without significant difference in complication rates<ref>{{Cite journal|last=Yang|first=Yi-Fan|last2=Dong|first2=Rui|last3=Zheng|first3=Chao|last4=Jin|first4=Zhu|last5=Chen|first5=Gong|last6=Huang|first6=Yan-Lei|last7=Zheng|first7=Shan|date=2016-07|title=Outcomes of thoracoscopy versus thoracotomy for esophageal atresia with tracheoesophageal fistula repair: A PRISMA-compliant systematic review and meta-analysis|url=https://pubmed.ncbi.nlm.nih.gov/27472740|journal=Medicine|volume=95|issue=30|pages=e4428|doi=10.1097/MD.0000000000004428|issn=1536-5964|pmc=5265877|pmid=27472740}}</ref>. The major steps are the same for both approaches. The distal and proximal esophageal segments are identified, as well as the trachea and fistula. The azygos vein and vagus nerve are also identified, and care is taken to avoid damage to these structures. The fistula is clipped or suture ligated proximal to the trachea. Importantly, the fistula may not be divided following closure to prevent contracture of the connected esophageal segment. At this point, the proximal and distal esophageal segments are opened. A nasogastric tube is placed across them under direct visualization to guide the anastomosis and ensure patency<ref name=":1" />.

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|Review imaging prior to patient evaluation to confirm the fistula type. There are several options for intubation, including general endotracheal intubation, or intentional main stem intubation below the level of the fistula. Plan should be made based on the number of fistulae, whether they are proximal or distal, and relative position to the carina. Bronchoscopy may also be performed immediately prior to surgery<ref name=":1" />.
|-
|Cardiovascular
|VACTERL anomalies may be present, including cyanotic CHD, situs inversus, right sided aortic arch, arrhythmia, or others. These should be screened for prior to the procedure, and considered when making an anesthetic plan<ref name=":2" />.
|-
|Pulmonary
|Respiratory distress may be present to varying degrees. Most fistula types result in increased gastric air, increasing abdominal pressure and difficulty ventilating. If the patient is currently intubated, confirm vent settings, assess ETCO2, and get a VBG to determine adequacy of ventilation.
|-
|Gastrointestinal
|Confirming the fistula type by radiography is an important pre-operative step. This is typically done by attempting to pass an orogastric tube (commonly, a Repogle tube) and taking a chest and abdominal X-ray. Coiling of the tube in the proximal esophagus indicates the presence of atresia, while the presence or absence of air in the stomach and intestines.
|-
|Renal
|Renal anomalies may be seen as part of the VACTERL association. Preoperative chemistries should be evaluated.
|-
|Musculoskeletal
|Vertebral anomalies may be present in the VACTERL association. Cervical vertebral malformations, abnormal curvature, and tethered cord syndrome may be present, and should be considered prior to intubation.
|}

=== Labs and studies ===

* Chest and abdominal X-rays aid in diagnosis and can help identify fistula type as described above
* Echocardiography should be considered, but may not be necessary in the absence of abnormal cardiac exam findings<ref>{{Cite journal|last=Nasr|first=Ahmed|last2=McNamara|first2=Patrick J.|last3=Mertens|first3=Luc|last4=Levin|first4=David|last5=James|first5=Andrew|last6=Holtby|first6=Helen|last7=Langer|first7=Jacob C.|date=2010-05|title=Is routine preoperative 2-dimensional echocardiography necessary for infants with esophageal atresia, omphalocele, or anorectal malformations?|url=https://pubmed.ncbi.nlm.nih.gov/20438917|journal=Journal of Pediatric Surgery|volume=45|issue=5|pages=876–879|doi=10.1016/j.jpedsurg.2010.02.002|issn=1531-5037|pmid=20438917}}</ref>.
* CBC, CMP, and Blood Gasses should all be considered pre-op.

== Intraoperative management ==

=== Monitoring and access ===

* Blood Pressure: Invasive blood pressure monitoring may be indicated for patients with associated cardiac anomalies.
* Pulse Oximetry and EtCO2: Important for monitoring adequacy of ventilation.
* Telemetry Monitoring
* Temperature Monitoring
* PIVs

=== Induction<ref>{{Cite journal|last=Diaz|first=Laura K.|last2=Akpek|first2=Elif A.|last3=Dinavahi|first3=Radhika|last4=Andropoulos|first4=Dean B.|date=2005-10|title=Tracheoesophageal fistula and associated congenital heart disease: implications for anesthetic management and survival|url=https://pubmed.ncbi.nlm.nih.gov/16176315|journal=Paediatric Anaesthesia|volume=15|issue=10|pages=862–869|doi=10.1111/j.1460-9592.2005.01582.x|issn=1155-5645|pmid=16176315}}</ref><ref name=":3">{{Cite journal|last=Broemling|first=Natasha|last2=Campbell|first2=Fiona|date=2011-11|title=Anesthetic management of congenital tracheoesophageal fistula|url=https://pubmed.ncbi.nlm.nih.gov/20723095|journal=Paediatric Anaesthesia|volume=21|issue=11|pages=1092–1099|doi=10.1111/j.1460-9592.2010.03377.x|issn=1460-9592|pmid=20723095}}</ref> ===

* Inhalational inductions are typically used, favored for their hemodynamic stability.
* Propofol or Dexmedetomidine should be on hand, and may be used if rapid IV induction is needed.
* Muscle relaxing agents (eg. Rocuronium) may be used depending on the chosen airway management strategy.

=== Airway management ===
{| class="wikitable"
|+
! colspan="2" |Strategies for airway management (as described in Broemling and Campbell<ref name=":3" />)
|-
|Spontaneous Ventilation
|Positive pressure ventilation increases the risk of gastric insufflation and ventilatory compromise. Physiologic negative pressure ventilation lowers the risk of increasing airflow through the fistula. In patients with good pulmonary compliance or demonstrated easy masking without gastric distention, spontaneous ventilation may be tried, knowing standard intubation and PPV is a viable backup.
|-
|Main Stem Intubation and One-Lung Ventilation
|This method allows for collapse of the lung in the operative field during fistula ligation. The tube can often be retracted to the trachea following fistula ligation. Main stem intubation typically requires increased FiO2 and flow rates to maintain adequate oxygenation.
|-
|Distal-Fistula Intubation
|Intubation distal to the fistula can allow for bilateral ventilation with positive pressure for neonates with respiratory failure. Caution must be used to ensure the tube does not migrate into a main stem bronchus. Migration of the ETT into the fistula may also occur, and can have extremely morbid outcomes.
|-
|Fistula Occlusion
|Fistula occlusion via Fogarty catheter can also be considered, but is difficult to execute and may dislodge, occluding the central airways.
|}

=== Positioning ===
Positioning is lateral recumbent, typically with the right side elevated ~30º for thoracic access and proper positioning of the lung relative to the mediastinum<ref name=":1" />.

=== Maintenance and surgical considerations ===

* Inhaled agents are typically used for maintenance of anesthesia.
* Insufflation for thoracoscopy may lead to desaturations and decreased venous return. The patient should be converted to an open procedure in that case, with use of additional anesthetic and pain control as indicated. This may also indicate a need for neuromuscular blockade and positive pressure ventilation if not already in use.
* Following ligation of the fistula, positive pressure ventilation may be initiated if needed without concern for gastric distention.

=== Emergence ===

* Extubation depends on ventilatory needs post op, as well as concern for laryngomalacia or tracheomalacia, injury to the recurrent laryngeal nerve, or suspicion for other ventilatory complications. Patient may be transferred post op while still intubated<ref name=":3" />.

== Postoperative management ==

=== Disposition ===

* Patients may remain intubated following the case, and will need to be monitored in a Neonatal Intensive Care Unit as ventilatory support is weaned.
* Post-op enteral feeding may be administered through a trans-anastomotic nasogastric tube. This may shorten time on TPN<ref>{{Cite journal|last=Alabbad|first=Saleh I.|last2=Ryckman|first2=Jon|last3=Puligandla|first3=Pramod Shailendra|last4=Shaw|first4=Kenneth|last5=Nguyen|first5=Luong T.|last6=Laberge|first6=Jean-Martin|date=2009-05|title=Use of transanastomotic feeding tubes during esophageal atresia repair|url=https://pubmed.ncbi.nlm.nih.gov/19433166|journal=Journal of Pediatric Surgery|volume=44|issue=5|pages=902–905|doi=10.1016/j.jpedsurg.2009.01.027|issn=1531-5037|pmid=19433166}}</ref>, however subsequent reviews have found an increased risk of esophageal stricture and no significant reduction in anastomotic leak<ref>{{Cite journal|last=Wang|first=Chuan|last2=Feng|first2=Liwei|last3=Li|first3=Yanan|last4=Ji|first4=Yi|date=2018-12-12|title=What is the impact of the use of transanastomotic feeding tube on patients with esophageal atresia: a systematic review and meta-analysis|url=https://pubmed.ncbi.nlm.nih.gov/30541487|journal=BMC pediatrics|volume=18|issue=1|pages=385|doi=10.1186/s12887-018-1359-5|issn=1471-2431|pmc=6292097|pmid=30541487}}</ref>.

=== Pain management ===

* Opioid sparing techniques, such as regional anesthetics in the thorax, should be used with caution due to immature hepatic metabolism of these agents<ref name=":3" />.

=== Potential complications<ref>{{Cite journal|last=Lal|first=Dave R.|last2=Gadepalli|first2=Samir K.|last3=Downard|first3=Cynthia D.|last4=Ostlie|first4=Daniel J.|last5=Minneci|first5=Peter C.|last6=Swedler|first6=Ruth M.|last7=Chelius|first7=Thomas|last8=Cassidy|first8=Laura|last9=Rapp|first9=Cooper T.|last10=Deans|first10=Katherine J.|last11=Fallat|first11=Mary E.|date=2017-08|title=Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula|url=https://pubmed.ncbi.nlm.nih.gov/27993359|journal=Journal of Pediatric Surgery|volume=52|issue=8|pages=1245–1251|doi=10.1016/j.jpedsurg.2016.11.046|issn=1531-5037|pmid=27993359}}</ref> ===
Complications were noted in the cited review in as many as 62% of cases, with the most common being:

* Esophageal Stricture (42%)
* Anastomotic Leak (23%)
* Vocal Cord Injury (7%)
* Recurrent Fistula (5%)
* Anastomotic dehiscence (2%)

These may lead to additional consequences, such as chylothorax, empyema, pleural effusion, pneumothorax, and issues with growth and development<ref name=":0" />.

== References ==
<references />
[[Category:Surgical procedures]]

2023-08-16T21:34:33Z

Agfasman: Added Repair of Tracheoesophageal Fistula link to pediatric surgery section in the surgical procedures

The '''table of contents''' is a non-comprehensive list of articles the editors of WikiAnesthesia feel should exist and will continuously evolve as the site grows from contributions from the anesthesia community.

Links which are '''blue''' already exist on the wiki (but would surely benefit from additions and revisions). Links which are '''red''' do not currently exist as articles on the site. Articles may exist in more than one location in the table of contents.

Please see our '''[[WikiAnesthesia:Author guide|author guide]]''' for instructions on how to start editing content on the site.

If you add a new article which is not currently listed but has a natural place in the table of contents, please edit this list to include it. We kindly ask that you do not make major changes to the table of contents before running it by an [{{fullurl:Special:ListUsers|group=editor}} editor] first.
=[[:Category:Surgical procedures|Surgical procedures]]=

==[[:Category:Cardiac surgery|Cardiac surgery]]==
*[[Aortic procedures]]
**[[Aortic aneurysm repair|Aortic aneurysm repair (AAA)]]
**[[Aortoplasty for supravalvular stenosis]]
**[[Repair of aortic aneurysm with graft]]
*[[Circulatory assist procedures]]
**[[Cardiopulmonary bypass|Cardiopulmonary bypass (CPB)]]
**[[Extracorporeal membrane oxygenation|Extracorporeal membrane oxygenation (ECMO)]]
**[[Insertion of ventricular assist device]] (Redirects: [[LVAD]], [[RVAD]], [[BiVAD]])
**[[Insertion of permanently implantable aortic counterpulsation ventricular assist device|Insertion of permanently implantable aortic counterpulsation ventricular assist device (VAD)]]
**[[Insertion of percutaneous ventricular assist device|Insertion of percutaneous ventricular assist device (pVAD)]]
**[[Implantation of total replacement heart system]]
*[[Electrophysiology procedures]]
**[[Insertion of pacemaker or ICD]]
**[[Intracardiac catheter ablation for the treatment of arrhythmia]]
**[[Loop recorder implantation]]
*[[Myocardial procedures]]
**[[Excision of intracardiac tumor]]
**[[Ventriculomyotomy]]
**[[Ventricular aneurysmectomy]]
*[[Cardiac revascularization procedures]]
**[[Coronary artery bypass graft|Coronary artery bypass graft (CABG)]]
**[[Off-pump and minimally invasive coronary artery bypass grafting|Off-pump and minimally invasive coronary artery bypass grafting (OPCAB)]]
**[[Percutaneous transluminal coronary angioplasty|Percutaneous transluminal coronary angioplasty (PTCA)]]
**[[Transmyocardial laser revascularization]]
**[[Coronary endarterectomy]]
*[[Pericardial procedures]]
**[[Pericardiocentesis]]
**[[Pericardiectomy]]
*[[Septal procedures]]
**[[Septal myectomy/myotomy]]
**[[Transcatheter closure of ASD or VSD]]
**[[Open repair of ASD or VSD]]
*Transplant procedures
**[[Heart transplant]]
**[[Heart-lung transplant]]
**[[Lung transplant]] (Redirect: [[BOLT]])
*[[Valvular procedures]]
**[[Transcatheter aortic valve replacement|Transcatheter aortic valve replacement (TAVR)]]
**[[Transcatheter mitral valve replacement|Transcatheter mitral valve replacement (TMVR)]]
**[[Aortic valve repair or replacement|Aortic valve repair or replacement (AVR)]]
**[[Mitral valve repair or replacement|Mitral valve repair or replacement (MVR)]]
**[[Tricuspid valve repair or replacement]]
**[[Percutaneous balloon valvuloplasty]]

==[[:Category:General surgery|General surgery]]==
*[[Biliary tract surgery]]
**[[Cholecystectomy]]
**[[Excision of bile duct tumor]]
**[[Choledochal cyst excision or anastomosis]]
**[[Percutaneous transhepatic biliary drainage]]
**[[Percutaneous transhepatic cholangiography]]
**[[Endoscopic retrograde cholangiopancreatography]]
*[[Breast surgery]]
**[[Mastectomy]]
**[[Breast biopsy]]
**[[Breast lumpectomy]]
**[[Sentinel lymph node biopsy]]
*[[Colorectal surgery]]
**[[Anorectal surgery]]
***[[Hemorrhoidectomy]]
***[[Lateral internal sphincterotomy]]
***[[Incision and drainage of perianal abscess]]
***[[High resolution anoscopy|High resolution anoscopy (HRA)]]
***[[Sacral nerve stimulation for fecal incontinence]]
**[[Colectomy]]
**[[Pelvic exenteration]]
**[[Proctectomy]]
**[[Rectal prolapse surgery]]
***[[Mucosal sleeve resection|Mucosal sleeve resection (Delorme Procedure)]]
***[[Perineal rectosigmoidectomy]]
***[[Rectopexy]]
*[[Endocrine surgery]]
**[[Adrenalectomy]]
***[[Excision of pheochromocytoma]]
**[[Thyroidectomy]]
**[[Parathyroidectomy]]
*[[Esophageal surgery]]
**[[Cervical esophagostomy]]
**[[Esophagectomy]]
***[[Thoracoabdominal esophagectomy]]
***[[Minimally invasive esophagectomy]]
***[[Transhiatal esophagectomy]]
***[[Ivor Lewis esophagectomy]]
***[[McKeown esophagectomy]]
**[[Esophageal diverticulectomy]]
***[[Zenker's divericulectomy]]
**[[Esophagomyotomy]]
***[[Heller myotomy]]
**[[Esophagastric fundoplication]]
***[[Nissen fundoplication]]
***[[Belsey Mark fundoplication]]
**[[Surgical repair of esophageal perforation or rupture]]
*[[Hepatic surgery]]
**[[Hepatic resection]]
**[[Hepatorrhaphy]]
**[[Liver transplant]]
***[[Veno-Venous Bypass]]
*[[Intestinal surgery]]
**[[Appendectomy]]
**[[Closure of enteric fistula]]
**[[Duodenotomy]]
**[[Enterolysis procedure|Enterolysis procedure (Lysis of adhesions)]]
**[[Inguinal hernia repair]]
**[[Meckel's diverticulectomy]]
**[[Ostomy procedure]]
**[[Small bowel resection]]
**[[Ventral hernia repair]]
*[[Pancreatic surgery]]
**[[Pancreatectomy]]
**[[Pancreaticoduodenectomy|Pancreaticoduodenectomy (Whipple procedure)]]
*[[Splenic surgery]]
**[[Splenectomy]]
**[[Splenorrhaphy|Splenorrhaphy (Repair of ruptured spleen)]]
*[[Stomach surgery]]
**[[Gastric resection|Gastric resection (Gastrectomy)]]
**[[Percutaneous endoscopic gastrostomy|Percutaneous endoscopic gastrostomy (PEG)]]
**[[Gastric or duodenal perforation repair]]
**[[Bariatric surgery]]
***[[Gastric bypass surgery]]
****[[Roux-en-Y gastric bypass]]
****[[Biliopancreatic diversion with duodenal switch|Biliopancreatic diversion with duodenal switch (BPD/DS)]]
***[[Gastric restrictive surgery]]
****[[Laparoscopic adjustable gastric banding]]
****[[Open vertical sleeve gastrectomy]]
*[[Trauma surgery]]
*[[Hyperthermic intraperitoneal chemotherapy surgery|Hyperthermic intraperitoneal chemotherapy surgery (HIPEC)]]

==[[:Category:Interventional radiology procedures|Interventional radiology procedures]]==
*[[Superior vena cava recanalization]]

==[[:Category:Oral and maxillofacial surgery|Oral and maxillofacial surgery]]==
*[[Dental extraction]]

==[[:Category:Neurosurgery|Neurosurgery]]==
*[[Functional neurosurgery]]
**[[Deep brain stimulation lead placement]]
**[[Percutaneous trigeminal rhizotomy]]
**[[Vagus nerve stimulation|Vagus nerve stimulation (VNS)]]
**[[Responsive neurostimulation|Responsive neurostimulation (RNS)]]
*[[Intracranial neurosurgery]]
**[[Awake craniotomy|Awake craniotomy]]
**[[Bifrontal craniotomy for CSF leak]]
**[[Craniocervical decompression]]
**[[Craniotomy for cerebral embolectomy]]
**[[Craniotomy for decompression of cranial nerves]]
**[[Craniotomy for extracranial-intracranial revascularization|Craniotomy for extracranial-intracranial revascularization (EC-IC bypass)]]
**[[Craniotomy for intracranial aneurysm]]
**[[Craniotomy for intracranial vascular malformations]]
**[[Craniotomy for resection of epileptogenic focus]]
**[[Craniotomy for trauma]]
**[[Craniotomy for tumor resection]]
**[[Transphenoidal resection of pituitary tumor]]
*[[Spinal neurosurgery]]
**[[Anterior cervical spine surgery]]
**[[Posterior cervical spine surgery]]
**[[Anterior thoracic spine surgery]]
**[[Posterior thoracic spine surgery]]
**[[Anterior lumbar/lumbosacral spine surgery]]
**[[Posterior lumbar/lumbosacral spine surgery]]
*[[CSF aspiration, diversion, or shunt procedures]]
**[[Ventriculocisternostomy|Ventriculocisternostomy (Torkildsen shunt)]]
**[[Ventriculoperitoneal shunt|Ventriculoperitoneal shunt (VP shunt)]]
**[[Ventriculoatrial shunt|Ventriculoatrial shunt (VA shunt)]]
*[[Carotid endarterectomy|Carotid endarterectomy (CEA)]]
*Neuro interventional radiology procedures
**[[Cerebral angiogram]]

==[[:Category:Obstetric and gynecologic surgery|Obstetric and gynecologic surgery]]==
*[[Cesarean section]]
*[[Dilation and curettage|Dilation and curettage (D&C)]]
*[[Endometrial ablation]]
*[[Hysterectomy|Hysterectomy (TAH)]]
*[[Hysteroscopy]]
*[[Myomectomy|Myomectomy (Fibroidectomy)]]
*[[Oophorectomy|Oophorectomy (BSO)]]
*[[Ovarian torsion surgery]]
*[[Pelvic exenteration]]
*[[Tubal ligation]]
*[[Vaginectomy]]

==[[:Category:Ophthalmology|Ophthalmology]]==
*[[Cataract surgery|Cataract surgery]]
*[[Corneal transplant]]
*[[Traveculectomy]]
*[[Ectropion repair]]
*[[Entropion repair]]
*[[Ptosis repair]]
*[[Eyelid reconstruction]]
*[[Pterygium excision]]
*[[Repair of ruptured of lacerated globe]]
*[[Dacryocystorhinostomy|Dacryocystorhinostomy (DCR)]]
*[[Enucleation]]
*[[Orbitotomy]]

==[[:Category:Orthopedic surgery|Orthopedic surgery]]==
*[[Foot and ankle surgery]]
*[[Hand surgery]]
**[[Hand or digit replantation]]
**[[Carpal tunnel release]]
**[[Fixation of fractures and dislocations of the wrist and hand]]
**[[Wrist arthroscopy]]
**[[Darrach procedure]]
**[[Arthrodesis of the wrist]]
**[[Excision of ganglion of the wrist]]
**[[Palmar and digital fasciectomy]]
**[[Repair of laceracted nerves/tendons of the hand]]
*[[Hip surgery]]
**[[Hip arthroplasty|Hip arthroplasty (THA)]]
*[[Lower leg surgery]]
**[[Open reduction and interal fixation of the tibial plateau fracture]]
*[[Joint replacement surgery]]
**[[Hip arthroplasty|Hip arthroplasty (THA)]]
**[[Knee arthroplasty|Knee arthroplasty (TKA)]]
**[[Shoulder arthroplasty|Shoulder arthroplasty (TSA)]]
*[[Knee surgery]]
**[[Knee arthroplasty|Knee arthroplasty (TKA)]]
*[[Orthopedic oncology surgery]]
*[[Shoulder surgery]]
**[[Shoulder arthroplasty|Shoulder arthroplasty (TSA)]]
*[[Spine surgery]]
*[[Sports surgery]]

==[[:Category:Otolaryngology|Otolaryngology]]==
*Airway procedures
**[[Bronchoscopy]]
**[[Deep extubation]]
**[[Laryngoscopy]]
*[[Ear, audiovestibular, and temporal bone procedures]]
**[[Cochlear implant surgery]]
**[[Tympanoplasty and/or mastoidectomy]]
*[[Esophageal surgery]]
**[[Esophageal diverticulectomy]]
**[[Esophagoscopy]]
*[[Jaw surgery]]
**[[Maxillary and mandibular osteotomy]]
**[[Temporomandibular joint surgery]]
*[[Pharyngeal surgery]]
**[[Glossectomy]]
**[[Tonsillectomy and/or adenoidectomy]]
*[[Nasal surgery]]
**[[Rhinectomy]]
**[[Rhinoplasty and/or septoplasty]]
*[[Neck surgery]]
**[[Brachial cleft cyst excision]]
**[[Cricothyroidotomy]]
**[[Laryngectomy]]
**[[Laryngoplasty]]
**[[Lymph node biopsy]]
**[[Platysmaplasty|Platysmaplasty (Neck lift)]]
**[[Submandibular gland excision]]
**[[Thyroid radiofrequency ablation]]
**[[Tracheal resection]]
**[[Tracheotomy]]
*[[Salivary and parotid surgery]]
**[[Parotidectomy]]
*[[Sinus surgery]]
**[[Functional endoscopic sinus surgery|Functional endoscopic sinus surgery (FESS)]]
**[[Maxillectomy]]

==[[:Category:Pediatric surgery|Pediatric surgery]]==
*[[Pediatric cardiac surgery]]
**[[Anastomosis of pulmonary artery to aorta]] (Redirects: [[Damus-Kaye-Stan procedure]])
**[[Ascending aorta to pulmonary artery shunt]] (Redirects: [[Waterson shunt]])
**[[Banding of pulmonary artery]]
**[[Descending aorta to pulmonary artery shunt]] (Redirects: [[Potts-Smith shunt]])
**[[Excision of coarctation of aorta]]
**[[Repair of pulmonary venous stenosis]]
**[[Repair of anomalous pulmonary venous return]]
**[[Repair of hypoplastic or interrupted aortic arch]]
**[[Repair of transposition of the great arteries]]
**[[Repair of truncus arteriosus]] (Redirects: [[Rastelli procedure]])
**[[Repair of patent ductus arteriosus]]
**[[Subclavian to pulmonary artery shunt]] (Redirects: [[Blalock-Taussig shunt]])
**[[Superior vena cava to pulmonary artery]] (Redirects: [[Glenn procedure]])
**Transcatheter Pulmonary Valve Implantation
**Cardiac Catheterization
*[[Pyloromyotomy]]
*[[Repair of tracheoesophageal fistula (TEF)]]
*[[Pediatric neurosurgery]]
*[[Pediatric otorhinolaryngology]]
**[[Myringotomy for ear tubes]]
*[[Pediatric urology]]
**[[Circumcision]]
**[[Orchiopexy]]
**[[Meatoplasty]]
**[[Bladder exstrophy repair]]
**[[Hypospadias repair]]

==[[:Category:Plastic and reconstructive surgery|Plastic and reconstructive surgery]]==
*[[Burn surgery]]
**[[Burn wound debridement]]
**[[Burn wound skin grafting]]
**[[Burn wound scar revision]]
**[[Laser treatment for burn scar]]
*[[Panniculectomy]]
*[[Platysmaplasty|Platysmaplasty (Neck lift)]]

==[[:Category:Thoracic surgery|Thoracic surgery]]==
*[[Bronchopulmonary lavage]]
*[[Chest wall resection]]
*[[Diaphragmatic plication]]
*[[Drainage of empyema]]
*[[Endobronchial ultrasound-guided transbronchial needle aspiration]] (Redirects: [[EBUS-TBNA]])
*[[Lobectomy]] (Redirects: [[Wedge resection]])
*[[Lung volume reduction surgery]]
*[[Mediastinal tumor resection]]
*[[Mediastinoscopy]]
*[[Surgery for pleural mesothelioma|Pleural mesothelioma]]
*[[Pneumonectomy]]
*[[Repair of pectus excavatum or carinatum]]
*[[Thoracoplasty]]
*[[Thymectomy]]
*[[Tracheal resection]]
*[[Video-assisted thoracoscopic surgery]] (Redirects: [[VATS]])

==[[:Category:Vascular surgery|Vascular surgery]]==
*[[Arteriovenous access for hemodialysis]]
*[[Carotid endarterectomy|Carotid endarterectomy (CEA)]]
*[[Endovascular aortic repair|Endovascular aortic repair (TEVAR)]]
*[[Infrainguinal arterial bypass]]
*[[Lumbar sympathectomy]]
*[[Permanent vascular access]]
*[[Thoracic outlet syndrome surgery]]
*[[Transjugular intrahepatic portosystemic shunts|Transjugular intrahepatic portosystemic shunts (TIPS)]]
*[[Varicose vein stripping and ablation]]
*[[Femoral artery endarterectomy]]

==[[:Category:Urology|Urology]]==
*[[Brachytherapy]]
*[[Circumcision]]
*[[Cystectomy]]
*[[Cystoscopy]]
*[[Hypospadias repair]]
*[[Kidney transplant]]
*[[Lithotripsy]]
*[[Nephrectomy]]
*[[Nephrostomy]]
*[[Orchiectomy]]
*[[Penectomy]]
*[[Percutaneous nephrolithotomy or nephrolithotripsy]]
*[[Prostatectomy|Prostatectomy (TURP)]]
*[[Pelvic exenteration]]
*[[Suprapubic cystostomy]]
*[[Transurethral resection of bladder tumor|Transurethral resection of bladder tumor (TURBT)]]

==[[:Category:Out-of-operating room procedures|Out-of-operating room procedures]]==
*[[Cardioversion]]
*[[Electroconvulsive therapy|Electroconvulsive therapy (ECT)]]
*[[Gastroenterology procedures]]
**[[Endoscopic retrograde cholangiopancreatography|Endoscopic retrograde cholangiopancreatography (ERCP)]]
**[[Colonoscopy]]
**[[Upper GI endoscopy|Upper GI endoscopy (EGD)]]

=[[Airway management]]=
*[[Airway anatomy]]
*[[Airway assessment]]
*[[Aspiration under anesthesia]]
*[[Cormack-Lehane grading system]]
*[[Deep extubation]]
*[[Difficult airway algorithm]]
*[[Endobronchial intubation]] (Redirects: [[Mainstem intubation]])
*[[Mallampati score]]
*[[One-lung ventilation]]
**[[Bronchial blocker]]
**[[Double-lumen endotracheal tube]]
*[[Pediatric airway management]]
*[[Preoxygenation]]
*[[Transtracheal ventilation]]

==[[Airway equipment]]==
*[[Bougie]]
*[[Breathing circuits]] (Redirects: [[Ayre's T-piece]], [[Bain system]], [[Jackson-Rees]], [[Lack system]], [[Magill system]], [[Mapleson A]], [[Mapleson B]], [[Mapleson C]], [[Mapleson D]], [[Mapleson E]], [[Mapleson F]], [[Waters bag]])
*[[Bronchial blocker]]
*Endotracheal tubes
**[[Double-lumen endotracheal tube]] (Redirects: [[DLT]], [[Double-lumen endobronchial tube]])
**[[Endotracheal tube]] (Redirects: [[ETT]])
**[[Electromyographic endotracheal tube]] (Redirects: [[EMG ETT]], [[NIM EMG ETT]])
**[[Laser-resistant endotracheal tube]] (Redirects: [[Laser ETT]])
**[[Microlaryngeal endotracheal tube]] (Redirects: [[Microlaryngoscopy tube]], [[MLT]])
**[[Reinforced endotracheal tube]] (Redirects: [[Armored endotracheal tube]], [[Wire-reinforced endotracheal tube]])
**[[Ring-Adair-Elwyn endotracheal tube]] (Redirects: [[Nasal RAE ETT]], [[Oral RAE ETT]], [[RAE ETT]])
*Laryngoscope blades
**[[Macintosh laryngoscope blade]] (Redirects: [[MAC]])
**[[Miller laryngoscope blade]] (Redirects: [[Miller]])
**[[Wis-Hipple laryngoscope blade]] (Redirects: [[Miller]])
*[[Lighted stylet]] (Redirects: [[Lightwand]])
*[[Magill forceps]]
*Noninvasive ventilation
**[[Bag valve mask]] (Redirects: [[Ambu bag]], [[BVM]])
**[[Nasal cannula]]
**[[Non-rebreather mask]]
**[[High-flow nasal cannula]] (Redirects: [[HFNC]])
*Supraglottic airways
**[[Combitube]] (Redirects: [[Esophageal-tracheal double-lumen tube]])
**[[Laryngeal tube]] (Redirects: [[King LT]])
**[[Nasopharyngeal airway]] (Redirects: [[Nasal airway]])
**[[Oropharyngeal airway]] (Redirects: [[Oral airway]])
**Laryngeal mask airways
***[[Laryngeal mask airway]] (Redirects: [[LMA]])
***[[LMA Fastrach]] (Redirects: [[Intubating LMA]])
***[[LMA ProSeal]]
***[[LMA Unique]]
***[[LMA Supreme]]
***[[I-gel LMA]] (Redirects: [[IGel LMA]])
*[[Video laryngoscopes]]
**[[C-Mac]]
**[[Glidescope]]
*[[Yankauer suction tip]]

==[[:Category:Airway procedures|Airway procedures]]==
*[[Cricothyrotomy]] (Redirects: [[Cric]], [[Crike]], [[Thyrocricotomy]], [[Cricothyroidotomy]], [[Needle cricothyrotomy]])
*[[Endotracheal intubation]] (Redirects: [[Intubation]])
**[[Asleep fiberoptic intubation]]
**[[Awake fiberoptic intubation]]
**[[Nasal intubation]]
**[[Oral intubation]]
**[[Retrograde intubation]]
*[[Laryngoscopy]]
**[[Direct laryngoscopy]] (Redirects: [[DL]])
**[[Indirect laryngoscopy]] (Redirects: [[Fiberoptic laryngoscopy]], [[VL]], [[Video laryngoscopy]])
*[[Tracheotomy]] (Redirects: [[Tracheostomy]])

=Anatomy and physiology=
*[[Acid-base homeostasis]]
*[[Cerebral physiology]]
*[[Consciousness]]
*[[Cardiovascular anatomy and physiology]]
*[[Gastrointestinal physiology]]
*[[Hematology]]
* [[Hepatic physiology]]
* [[Renal physiology]]
* [[Respiratory physiology]]

= [[:Category:Comorbidities|Comorbidities]] =

== [[Acid-base disorders]] ==
* [[Metabolic acidosis]] (Redirects: [[Anion gap metabolic acidosis]], [[Diabetic ketoacidosis]], [[DKA]], [[High anion gap metabolic acidosis]], [[Hyperchloremic acidosis]], [[Ketoacidosis]], [[Lactic acidosis]], [[Nongap metabolic acidosis]], [[Normal anion gap metabolic acidosis]], [[Renal tubular acidosis]], [[RTA]])
* [[Metabolic alkalosis]] (Redirects: [[Contraction alkalosis]])
* [[Respiratory acidosis]]
* [[Respiratory alkalosis]]

== Cardiovascular disorders ==
* [[Acute coronary syndrome]] (Redirects: [[MI]], [[Myocardial infarction]], [[Myocardial ischemia]], [[Unstable angina]])
* [[Angina pectoris]] (Redirects: [[Prinzmetal's angina]], [[Stable angina]])
* [[Aortic aneurysm]]
* [[Aortic dissection]] (Redirects: [[Type A dissection]], [[Type B dissection]])
* [[Aortic rupture]]
* [[Arteriovenous malformation]] (Redirects: [[AVM]], [[Cerebral arteriovenous malformation]], [[Cerebral AVM]])
* [[Brugada syndrome]]
* [[Cardiac arrhythmias]]
** [[Asystole]]
** [[Atrial fibrillation]] (Redirects: [[Afib]])
** [[Atrial flutter]] (Redirects: [[Aflutter]])
** [[Bradycardia]] (Redirects: [[Sinus bradycardia]])
** [[Drug-induced QT prolongation]] (Redirects: [[QT prolongation]])
** [[Junctional rhythm]]
** [[Long QT syndrome]] (Redirects: [[Romano-Ward syndrome]])
** [[Pulseless electrical activity]] (Redirects: [[PEA]])
** [[Sick sinus syndrome]] (Redirects: [[Tachycardia-bradycardia syndrome]])
** [[Ventricular fibrillation]]
** [[Wandering atrial pacemaker]]
** [[Wolff-Parkinson-White syndrome]] (Redirects: [[WPW]])
** [[Heart block]] (Redirects: [[Atrioventricular block]], [[AV block]], [[SA block]], [[Sinoatrial block]])
*** [[Bundle branch block]] (Redirects: [[Bifascicular block]])
**** [[Left anterior fascicular block]] (Redirects: [[LAFB]])
**** [[Left bundle branch block]] (Redirects: [[LBBB]])
**** [[Left posterior fascicular block]] (Redirects: [[LPFB]])
**** [[Right bundle branch block]] (Redirects: [[RBBB]])
*** [[First-degree atrioventricular block]] (Redirects: [[1st-degree atrioventricular block]])
*** [[Second-degree atrioventricular block]] (Redirects: [[2nd-degree atrioventricular block]], [[Mobitz I]], [[Mobitz II]], [[Wenckebach block]])
*** [[Third-degree atrioventricular block]] (Redirects: [[3rd-degree atrioventricular block]], [[Complete heart block]], [[Trifascicular block]])
** [[Premature contraction]]
*** [[Premature atrial contraction]] (Redirects: [[PAC]])
*** [[Premature junctional contraction]] (Redirects: [[PJC]])
*** [[Premature ventricular contraction]] (Redirects: [[PVC]])
** [[Tachycardia]]
*** [[Supraventricular tachycardia]] (Redirects: [[SVT]])
**** [[Atrioventricular reentrant tachycardia]] (Redirects: [[AVRT]])
**** [[AV-nodal reentrant tachycardia]] (Redirects: [[AVNRT]])
**** [[Multifocal atrial tachycardia]]
**** [[Sinus tachycardia]]
*** [[Ventricular tachycardia]]
* [[Cardiac tamponade]]
* [[Cardiomyopathy]]
** [[Arrhythmogenic cardiomyopathy]]
** [[Dilated cardiomyopathy]]
** [[Hypertrophic cardiomyopathy]] (Redirects: [[HOCM]])
** [[Restrictive cardiomyopathy]]
** [[Takotsubo cardiomyopathy]] (Redirects: [[Broken heart syndrome]], [[Stress cardiomyopathy]])
** [[Tachycardia-induced cardiomyopathy]]
* Cardiomegaly
** [[Left atrial enlargement]] (Redirects: [[LAE]])
** [[Left ventricular hypertrophy]] (Redirects: [[LVH]])
** [[Right atrial enlargement]] (Redirects: [[RAE]])
** [[Right ventricular hypertrophy]] (Redirects: [[RVH]])
* [[Congenital heart defects]]
** [[Absent pulmonary valve syndrome]]
** [[Aortopulmonary septal defects]]
*** [[Aortopulmonary window]]
*** [[Double outlet right ventricle]] (Redirects: [[DORV]])
*** [[Persistent truncus arteriosus]] (Redirects: [[PTA]])
*** [[Taussig-Bing syndrome]]
*** [[Transposition of the great vessels]] (Redirects: [[d-TGA]], [[dextro-Transposition of the great arteries]], [[l-TGA]], [[levo-Transposition of the great arteries]], [[TGA]], [[TGV]])
** [[Atrial septal defect]] (Redirects: [[ASD]], [[Sinus venosus atrial septal defect]])
** [[Atrioventricular septal defect]] (Redirects: [[Atrioventricular canal defect]], [[Endocardial cushion defect]], [[AVSD]], [[Ostium primum atrial septal defect]])
** [[Bicuspid aortic valve]]
** [[Cor triatriatum]]
** [[Coronary artery anomaly]] (Redirects: [[AAOCA]], [[Anomalous aortic origin of a coronary artery]])
** [[Crisscross heart]]
** [[Dextrocardia]]
** [[Ebstein's anomaly]]
** [[Hypoplastic left heart syndrome]]
** [[Hypoplastic right heart syndrome]] (Redirects: [[Uhl anomaly]])
** [[Lutembacher's syndrome]]
** [[Tetralogy of Fallot]]
** [[Ventricular inversion]]
** [[Ventricular septal defect]] (Redirects: [[VSD]])
* [[Congenital vascular malformations]]
** [[Aberrant subclavian artery]]
** [[Anomalous pulmonary venous connection]] (Redirects: [[Partial anomalous pulmonary venous connection]], [[Scimitar syndrome]], [[Total anomalous pulmonary venous connection]])
** [[Aneurysm of sinus of Valsalva]]
** [[Coarctation of the aorta]]
** [[Congenital stenosis of vena cava]]
** [[Double aortic arch]]
** [[Interrupted aortic arch]]
** [[Overriding aorta]]
** [[Patent ductus arteriosus]] (Redirects: [[PDA]])
** [[Persistent left superior vena cava]]
** [[Pulmonary atresia]]
** [[Right-sided aortic arch]]
** [[Stenosis of pulmonary artery]]
** [[Vascular ring]]
* [[Coronary artery disease]] (Redirects: [[CAD]])
* [[Coronary steal syndrome]] (Redirects: [[Cardiac steal syndrome]])
* [[Endocarditis]] (Redirects: [[Acute bacterial endocarditis]], [[Infective endocarditis]], [[Nonbacterial thrombotic endocarditis]], [[Subacute bacterial endocarditis]])
* [[Heart failure]] (Redirects: [[Biventricular heart failure]], [[CHF]], [[Congestive heart failure]], [[Left-sided heart failure]], [[Right-sided heart failure]])
** [[Heart failure with reduced ejection fraction]] (Redirects: [[HFrEF]], [[Systolic heart failure]])
** [[Heart failure with preserved ejection fraction]] (Redirects: [[HFpEF]], [[Diastolic dysfunction]], [[Diastolic heart failure]])
** [[Pulmonary heart disease]]
* [[Gestational hypertension]]
* [[Hypertension (comorbidity)]] (Redirects: [[Essential hypertension]], [[HTN]])
* [[Pericardial effusion]]
* [[Pericarditis]]
* [[Peripheral artery disease]] (Redirects: [[PAD]])
* [[Pulmonary embolism]] (Redirects: [[PE]])
* [[Pulmonary heart disease]] (Redirects: [[Cor pulmonale]])
* [[Pulmonary hypertension]] (Redirects: [[PAH]], [[PH]], [[Pulmonary arterial hypertension]])
* [[Shock]]
** [[Cardiogenic shock]]
** [[Obstructive shock]]
** [[Distributive shock]] (Redirects: [[Septic shock]])
* [[Valvular heart disease]]
** [[Aortic stenosis]]
** [[Aortic regurgitation]]
** [[Mitral stenosis]]
** [[Mitral regurgitation]]
** [[Mitral valve prolapse]] (Redirects: [[MVP]])
** [[Pulmonary valve stenosis]]
** [[Pulmonary valve regurgitation]] (Redirects: [[Pulmonary valve insufficiency]])
** [[Tricuspid stenosis]] (Redirects: [[TS]])
** [[Tricuspid regurgitation]]

== Cerebrovascular disorders ==
* [[Anterior spinal artery syndrome]] (Redirects: [[Beck's syndrome]])
* [[Carotid artery stenosis]]
* [[Moyamoya disease]]
* [[Epidural hematoma]]
* [[Intracranial aneurysm]] (Redirects: [[Berry aneurysm]], [[Saccular aneurysm]])
* [[Intracranial hemorrhage]] (Redirects: [[Intracerebral hemorrhage]], [[Intraparenchymal hemorrhage]], [[Intraventricular hemorrhage]], [[SAH]], [[Subarachnoid hemorrhage]])
* [[Stroke]] (Redirects: [[Cerebral infarction]], [[Cerebrovascular accident]], [[CVA]], [[Hemorrhagic stroke]], [[Ischemic stroke]])
* [[Subdural hematoma]] (Redirects: [[SDH]])
* [[Vertebrobasilar insufficiency]] (Redirects: [[Subclavian steal syndrome]], [[VBI]])

== Electrolyte disorders ==
* [[Hypercalcemia]]
* [[Hyperkalemia]]
* [[Hypernatremia]]
* [[Hypocalcemia]]
* [[Hypokalemia]]
* [[Hyponatremia]] (Redirects: [[Hypotonic hyponatremia]], [[Isotonic hyponatremia]])

== Endocrine disorders ==
* [[Acromegaly]]
* [[Adrenal insufficiency]] (Redirects: [[Addison's disease]])
* [[Carcinoid syndrome]]
* [[Congenital adrenal hyperplasia]]
* [[Cushing's syndrome]]
* [[Diabetes insipidus]]
* [[Diabetes mellitus]]
** [[Gestational diabetes]]
** [[Type 1 diabetes]] (Redirects: [[DM1]], [[T1D]])
** [[Type 2 diabetes]] (Redirects: [[DM2]], [[T2D]])
* [[Hyperaldosteronism]] (Redirects: [[Bartter syndrome]], [[Conn syndrome]])
* [[Hyperlipidemia]] (Redirects: [[HLD]])
* [[Hyperparathyroidism]]
* [[Hyperthyroidism]] (Redirects: [[Graves' disease]], [[Thyrotoxicosis]])
* [[Hypoaldosteronism]]
* [[Hypoparathyroidism]]
* [[Hypothyroidism]] (Redirects: [[Cretinism]], [[Euthyroid sick syndrome]], [[Hashimoto's thyroiditis]], [[Myxedema]])
* [[Kallmann syndrome]]
* [[Multiple endocrine neoplasia]] (Redirects: [[Sipple syndrome]], [[Wagenmann-Froboese syndrome]], [[Wermer syndrome]])
* [[Obesity]]
* [[Pheochromocytoma]]
* [[Porphyria]] (Redirects: [[Acute intermittent porphyria]], [[AIP]])
* [[Serotonin syndrome]]
* [[Syndrome of inappropriate antidiuretic hormone secretion]] (Redirects: [[SIADH]])

== Gastrointestinal disorders ==
* [[Acute liver failure]] (Redirects: [[ALF]], [[Fulminant hepatic failure]], [[Hepatic encephalopathy]])
* [[Chronic liver disease]]
** [[Cirrhosis]] (Redirects: [[Chronic liver failure]])
** [[Hepatocellular carcinoma]]
* [[Gastroesophageal reflux disease]] (Redirects: [[Acid reflux]], [[GERD]], [[Heartburn]])
* [[Hepatitis]]
* [[Pyloric stenosis]]

== Genetic disorders ==
* [[Amyloidosis]]
* [[Andersen-Tawil syndrome]]
* [[Antithrombin III deficiency]]
* [[Arrhythmogenic cardiomyopathy]]
* [[Bartter syndrome]]
* [[Bernard-Soulier syndrome]]
* [[Brugada syndrome]]
* [[Congenital adrenal hyperplasia]]
* [[Congenital afibrinogenemia]]
* [[Crouzon syndrome]]
* [[Cystic fibrosis]] (Redirects: [[CF]])
* [[Down syndrome]] (Redirects: [[Trisomy 21]])
* [[Dysfibrinogenemia]]
* [[Edwards syndrome]] (Redirects: [[Trisomy 18]])
* [[Ehlers-Danlos syndromes]] (Redirects: [[EDS]])
* [[Epidermolysis bullosa]] (Redirects: [[EB]])
* [[Fabry disease]]
* [[Factor V Leiden]]
* [[Fanconi syndrome]]
* [[Friedreich's ataxia]]
* [[Gitelman syndrome]]
* [[Glanzmann's thrombasthenia]]
* [[Glycogen storage disease]] (Redirects: [[Aldolase A deficiency]], [[Andersen disease]], [[Cori's disease]], [[Forbes' disease]], [[Hers' disease]], [[McArdle disease]], [[Pompe disease]], [[Tarui's disease]], [[von Gierke's disease]])
* [[Gray platelet syndrome]]
* [[Hemophilia]]
* [[Hereditary hemorrhagic telangiectasia]] (Redirects: [[HHT]], [[Osler-Weber-Rendu syndrome]])
* [[Hermansky-Pudlak syndrome]]
* [[Huntington's disease]]
* [[Hypoprothrombinemia]]
* [[Hypertrophic cardiomyopathy]]
* [[Jervell and Lange-Nielsen syndrome]]
* [[Kallmann syndrome]]
* [[Klippel-Feil syndrome]]
* [[Liddle's syndrome]]
* [[Long QT syndrome]]
* [[Marfan syndrome]]
* [[May-Hegglin anomaly]]
* [[Multiple endocrine neoplasia]]
* [[Noonan syndrome]]
* [[Pierre Robin sequence]]
* [[Protein C deficiency]]
* [[Protein S deficiency]]
* [[Loeys-Dietz syndrome]]
* [[Muscular dystrophy]] (Redirects: [[Becker muscular dystrophy]], [[Duchenne muscular dystrophy]], [[Limb-girdle muscular dystrophy]], [[Myotonic muscular dystrophy]])
* [[Neurofibromatosis]]
* [[Mucopolysaccharidosis]] (Redirects: [[Hunter syndrome]], [[Hurler syndrome]], [[Maroteaux-Lamy syndrome]], [[Morquio syndrome]], [[Natowicz syndrome]], [[Sanfilippo syndrome]], [[Scheie syndrome]], [[Sly syndrome]])
* [[Sickle cell disease]]
* [[Timothy syndrome]]
* [[Treacher Collins syndrome]]
* [[VACTERL association]]
* [[von Willebrand disease]]

== Head and neck disorders ==
* [[Epiglottitis]]
* [[Laryngomalacia]]
* [[Laryngotracheal stenosis]]
* [[Pharyngeal abscess]] (Redirects: [[Peritonsillar abscess]], [[Retropharyngeal abscess]])
* [[Pharyngitis]] (Redirects: [[Strep throat]], [[Tonsillitis]])

== Hematologic disorders ==
* [[Coagulopathies]]
** [[Disseminated intravascular coagulation]] (Redirects: [[DIC]], [[Purpura fulminans]])
** Hypercoagulable disorders
*** [[Antiphospholipid syndrome]] (Redirects: [[APLS]], [[APS]])
*** [[Antithrombin III deficiency]] (Redirects: [[ATIII deficiency]])
*** [[Essential thrombocythemia]]
*** [[Factor V Leiden]]
*** [[Protein C deficiency]]
*** [[Protein S deficiency]]
** Hypocoagulable disorders
*** [[Evans syndrome]]
*** [[Bernard-Soulier syndrome]]
*** [[Congenital afibrinogenemia]]
*** [[Dysfibrinogenemia]]
*** [[Glanzmann's thrombasthenia]]
*** [[Gray platelet syndrome]]
*** [[Hemophilia]] (Redirects: [[Factor IX deficiency]], [[Factor VII deficiency]], [[Factor VIII deficiency]], [[Factor X deficiency]], [[Factor XI deficiency]], [[Factor XII deficiency]], [[Factor XIII deficiency]], [[Haemophilia]], [[Hemophilia A]], [[Hemophilia B]], [[Hemophilia C]])
*** [[Heparin-induced thrombocytopenia]] (Redirects: [[HIT]], [[HITT]])
*** [[Hermansky-Pudlak syndrome]]
*** [[Hypoprothrombinemia]]
*** [[Thrombocytopenic purpura]] (Redirects: [[Idiopathic thrombocytopenic purpura]], [[ITP]], [[Thrombotic Thrombocytopenic purpura]], [[TTP]], [[Upshaw–Schulman syndrome]])
*** [[May-Hegglin anomaly]]
*** [[von Willebrand disease]] (Redirects: [[vWD]])

== Mediastinal disorders ==
* [[Mediastinal mass]]
* [[Mediastinitis]]
* [[Pneumomediastinum]] (Redirects: [[Mediastinal emphysema]])

== Musculoskeletal disorders ==
* Congenital musculoskeletal disorders
** [[Craniosynostosis]]
** [[Down syndrome]]
** [[Goldenhar syndrome]]
** [[Klippel-Feil syndrome]] (Redirects: [[KFS]])
** [[Pierre Robin sequence]] (Redirects: [[PRS]])
** [[Treacher Collins syndrome]] (Redirects: [[TCS]])

== [[Neonatal emergencies]] ==
* [[Abdominal wall defects]]
** [[Gastroschisis]]
** [[Omphalocele]]
* [[Choanal atresia]]
* [[Congenital diaphragmatic hernia]]
* [[Esophageal atresia]]
* [[Intestinal obstruction]]
** [[Congenital aganglionic megacolon]] (Redirects: [[Hirschsprung's disease]])
** [[Intestinal atresia]]
** [[Intestinal malrotation]] (Redirects: [[Volvulus]]
** [[Meconium ileus]]
* [[Necrotizing enterocolitis]] (Redirects: [[NEC]])
* [[Pyloric stenosis]]
* [[Spina bifida]]
* [[Tracheoesophageal fistula]]

== Neurologic disorders ==
* [[Amyotrophic lateral sclerosis]] (Redirects: [[ALS]])
* [[Autonomic dysreflexia]]
* [[Chronic pain (comorbidity)]]
* [[Dementia]]
* [[Dysautonomia]]
* [[Essential tremor]]
* [[Huntington's disease]]
* [[Multiple sclerosis]]
* [[Myasthenia gravis]]
* [[Parkinson's disease]]
* [[Seizures]] (Redirects: [[Epilepsy]])
* [[Stroke]]

== Obstetric disorders==
* [[Amniotic fluid embolism]] (Redirects: [[AFE]])
* [[Ectopic pregnancy]]
* [[Fetal distress]]
* [[Gestational hypertension]]
* [[Gestational diabetes]]
* [[Nuchal cord]]
* [[HELLP syndrome]]
* [[Obstetrical bleeding]]
* [[Placenta accreta spectrum]] (Redirects: [[Accreta]], [[Increta]], [[Percreta]], [[Placenta accreta]], [[Placenta increta]], [[Placenta percreta]])
* [[Umbilical cord prolapse]]
* [[Uterine rupture]]
* [[Vasa previa]]

== Psychiatric disorders ==
* [[Generalized Anxiety disorder]] (Redirects: [[Anxiety]], [[GAD]])
* [[Major depressive disorder]] (Redirects: [[Depression]], [[MDD]])
* [[Substance abuse]] (Redirects: [[Drug abuse]])

== Pulmonary disorders ==
* [[Acute respiratory distress syndrome]] (Redirect: [[ARDS]])
* [[Asthma]]
* [[Atelectasis]]
* [[Chronic obstructive pulmonary disease]] (Redirects: [[COPD]])
* [[Cystic fibrosis]]
* [[Lung cancer]]
* [[Obstructive sleep apnea]] (Redirects: [[OSA]])
* [[Pleural effusion]]
* [[Pneumonia]]
* [[Pneumothorax]]
* [[Pulmonary edema]]
* [[Pulmonary embolism]] (Redirects: [[PE]])
* [[Pulmonary hypertension]]
* [[Severe acute respiratory syndrome coronavirus 2]] (Redirects: [[Coronavirus]], [[COVID-19]], [[SARS-CoV-2]])

== Renal disorders ==
* [[Acute renal failure]]
* [[Bartter syndrome]]
* [[Diabetes insipidus]]
* [[Chronic kidney disease]] (Redirects: [[CKD]])
* [[Fanconi syndrome]]
* [[Gitelman syndrome]]
* [[Liddle's syndrome]]
* [[Uremia]]

=Perioperative management=
*[[Enhanced recovery after surgery|Enhanced recovery after surgery (ERAS)]]
*[[Perioperative prevention of chronic pain]]
*[[Perioperative visual loss]]
==Preoperative management==
*[[Preoperative patient assessment]]
*[[Preoperative medication management|Preoperative medication management]]
*[[NPO guidelines]]
==Postoperative management==
*[[Postoperative pain management]]
===Postoperative complications===
*[[Dental injury]]
*[[Intraoperative awareness]]
*[[Postoperative nausea and vomiting|Postoperative nausea and vomiting (PONV)]]
*[[Residual neuromuscular blockade]]

=Intraoperative emergencies=
*[[Acute coronary syndrome]] (Redirects: [[MI]], [[Myocardial infarction]], [[Myocardial ischemia]])
*[[Amniotic fluid embolism]] (Redirects: [[AFE]])
*[[Anaphylaxis]]
*[[Asystole]]
*[[Bradycardia (intraoperative emergency)]]
*[[Bronchospasm]]
*[[Cardiac arrest]]
*[[Delayed emergence]]
*[[Difficult airway algorithm]]
*[[Fire (intraoperative emergency)]] (Redirects: [[Airway fire]])
*[[Hypertension (intraoperative emergency)]]
*[[Hypotension (intraoperative emergency)]]
*[[Hypoxemia (intraoperative emergency)]]
*[[Laryngospasm]]
*[[Local anesthetic systemic toxicity]] (Redirects: [[LAST]])
*[[Malignant Hyperthermia]]
*[[Oxygen failure]]
*[[Pneumothorax]]
*[[Power failure]]
*[[Total spinal anesthesia]]
*[[Transfusion reaction]]
*[[Pulseless electrical activity]] (Redirects: [[PEA arrest]])
*[[Supraventricular tachycardia (intraoperative emergency)]] (Redirects: [[SVT (intraoperative emergency)]])
*[[Venous air embolism]] (Redirects: [[VAE]])
*[[Ventricular fibrillation]] (Redirects: [[VF]], [[Vfib]])
*[[Ventricular tachycardia]] (Redirects: [[Monomorphic ventricular tachycardia]], [[Polymorphic ventricular tachycardia]], [[Torsades de pointes]], [[VT]], [[Vtach]])

=Intraoperative monitoring=
*[[Arterial blood pressure]] (Redirects: [[ABP]])
*[[Capnography]] (Redirects: [[End-tidal CO2]], [[EtCO2]])
*[[Central venous pressure]] (Redirects: [[CVP]])
*[[Cerebral oximetry]] (Redirects: [[ScO2]])
*[[Core temperature]]
*[[Echocardiography]]
**[[Transesophageal echocardiography]] (Redirects: [[TEE]])
**[[Transthoracic echocardiography]] (Redirects: [[TTE]])
*[[Electrocardiography]] (Redirects: [[5-lead electrocardiogram]], [[ECG]])
*[[Electroencephalography]] (Redirects: [[BIS]], [[Bispectral index]], [[EEG]], [[Entropy monitoring]], [[Patient state index]], [[PSI]], [[SedLine]], [[Spectral edge frequency]])
*[[Intracranial pressure]] (Redirects: [[ICP]])
*[[Neuromonitoring]]
**[[Brainstem auditory evoked potentials]] (Redirects: [[BAEPs]])
**[[Motor evoked potentials]] (Redirects: [[MEPs]])
**[[Somatosensory evoked potentials]] (Redirects: [[SSEPs]])
**[[Visual evoked potentials]] (Redirects: [[VEPs]])
*[[Pleth variability index]] (Redirects: [[PVI]])
*[[Pulse oximetry]] (Redirects: [[Plethysmography]], [[SpO2]])
*[[Pulse pressure variation]] (Redirects: [[PPV]])
*[[Precordial doppler]]
*[[Pulmonary artery pressure]] (Redirects: [[PAP]])
*[[Peripheral IV]] (Redirects: [[IV]], [[Large bore IV]], [[PIV]])
*[[Urine output]] (Redirects: [[UOP]])

= Neuraxial and regional anesthesia =
* [[Local anesthetics]]
* [[Local anesthetic adjuvants]]
* [[Local anesthetic toxicity]] (Redirects: [[LAST]])

==[[Neuraxial anesthesia]]==
*[[Caudal anesthesia]]
*[[Combined spinal-epidural anesthesia]] (Redirects: [[CSE]])
*[[Epidural anesthesia]] (Redirects: [[Epidural]])
**[[Lumbar epidural]]
**[[Thoracic epidural]]
*[[Post-dural-puncture headache]] (Redirects: [[PDPH]])
*[[Spinal anesthesia]] (Redirects: [[Spinal]])
*[[Total spinal anesthesia]]
*Ultrasound-guided neuraxial

== [[Regional anesthesia]] ==
* [[Bier block]]
* [[Local anesthetics]]
* [[Local anesthetic adjuvants]]

=== [[Head and neck nerve blocks]] ===
* [[Blocks for awake tracheal intubation]]
* [[Cervical plexus block]]
* [[Scalp block]]

=== [[Upper extremity nerve blocks]] ===
* [[Blocks at the elbow]]
* [[Brachial plexus blocks]]
** [[Interscalene block]]
** [[Supraclavicular block]]
** [[Infraclavicular block]]
** [[Axillary block]]
* [[Digital block]]
* [[Wrist block]]

=== [[Thoracic and abdominal wall blocks]] ===
* [[Intercostal nerve block]]
* [[Pectoralis nerve block]]
* [[Quadratus lumborum block]] (Redirects: [[QL block]])
* [[Serratus plane block]]
* [[Transversus abdominis plane block]] (Redirects: [[TAP block]])
* [[Truncal block]] (Redirects: [[Iliohypogastric nerve block]], [[Ilioinguinal nerve block]], [[Rectus sheath block]])

=== [[Lower extremity nerve blocks]] ===
* [[Ankle block]]
* [[Fascia iliaca block]]
* [[Femoral nerve block]]
* [[Lumbar plexus block]]
* [[Obturator nerve block]]
* [[Popliteal nerve block]]
* [[Saphenous nerve block]]
* [[Sciatic nerve block]]

= Pharmacology =
* [[Equianalgesic]] (Redirects: [[MME]], [[Morphine milligram equivalent]])
* [[Pharmacodynamics]]
* [[Pharmacokinetics]]
** [[Blood-gas partition coefficient]]
** [[Context sensitive half-life]]
** [[Drug metabolism]]
** [[Elimination]]
** [[Ion trapping]]
** [[Redistribution]]
*[[Pharmacogenetics and pharmacogenomics]]
**[[Pharmacogenetics and pharmacogenomics#Definitions and history|Definitions and history]]
**[[Pharmacogenetics and pharmacogenomics#Therapeutic class concerns|Therapeutic class concerns]]
**[[Pharmacogenetics and pharmacogenomics#Pediatric considerations|Pediatric considerations]]
**[[Pharmacogenetics and pharmacogenomics#Clinical implications and cost|Clinical implications and costs]]
**[[Pharmacogenetics and pharmacogenomics#Terminology|Terminology]]

== Drug reference ==
=== Acetylcholinesterase inhibitors ===
* [[Edrophonium]]
* [[Neostigmine]] (Redirects: [[Bloxiverz]])
* [[Physostigmine]]

=== [[Adrenergic receptor modulators]] ===
Redirects: [[Alpha agonists]], [[Alpha antagonists]], [[Beta agonists]]
* Alpha-1 agonists
** [[Ephedrine]]
** [[Epinephrine]] (Redirects: [[Adrenaline]])
** [[Norepinephrine]] (Redirects: [[Noradrenaline]])
** [[Phenylephrine]] (Redirects: [[Neosynephrine]])
* Alpha-1 antagonists
** [[Labetalol]]
** [[Phenoxybenzamine]]
** [[Phentolamine]]
* Alpha-2 agonists
** [[Clonidine]] (Redirects: [[Catapres]])
** [[Dexmedetomidine]] (Redirects: [[Precedex]])
* Beta agonists
** Beta-1 selective agonists
*** [[Dobutamine]]
** [[Ephedrine]]
** [[Epinephrine]]
** [[Isoprenaline]] (Redirects: [[Isoproterenol]])
** [[Norepinephrine]]
* [[Beta blockers]] (Redirects: [[Beta antagonists]])
** Beta-1 selective antagonists
*** [[Esmolol]] (Redirects: [[Brevibloc]])
*** [[Metoprolol]]
** [[Labetalol]]

=== [[Analgesics]] ===
* [[Acetaminophen]] (Redirects: [[Tylenol]])
* [[Analgesic adjuvants]]
** [[Gabapentin]] (Redirects: [[Neurontin]])
** [[Ketamine]]
** [[Lidocaine]]
** [[Pregabalin]] (Redirects: [[Lyrica]])
* [[Nonsteroidal anti-inflammatory drugs]] (Redirects: [[NSAIDs]])
** [[Aspirin]] (Redirects: [[Acetylsalicylic acid]])
** [[Celecoxib]] (Redirects: [[Celebrex]])
** [[Ibuprofen]]
** [[Ketorolac]] (Redirects: [[Toradol]])
* [[Opioid analgesics]]
** [[Alfentanil]]
** [[Buprenorphine]]
** [[Codeine]]
** [[Fentanyl]]
** [[Hydrocodone]]
** [[Hydromorphone]]
** [[Methadone]]
** [[Meperidine]]
** [[Morphine]]
** [[Oxycodone]]
** [[Remifentanil]]
** [[Sufentanil]]
**Piritramide

=== [[Antibiotics]] ===
* [[Cefazolin]] (Redirects: [[Ancef]], [[Kefzol]])
* [[Clindamycin]] (Redirects: [[Cleocin]])
* [[Vancomycin]]

=== Anticholinergics ===
* [[Atropine]]
* [[Glycopyrrolate]]

=== Antidotes ===
* [[Andexanet alfa]] (Redirects: [[Andexxa]])
* [[Atropine]]
* [[Dantrolene]]
* [[Flumazenil]]
* [[Glucagon]]
* [[Hydroxocobalamin]] (Redirects: [[Vitamin B12]])
* [[Idarucizumab]] (Redirects: [[Praxbind]])
* [[Methylene blue]] (Redirects: [[Methylthioninium chloride]])
* [[Physostigmine]]
* [[Naloxone]]
* [[Protamine]]
* [[Sugammadex]] (Redirects: [[Bridion]])

=== [[Antiemetics]] ===
* [[Aprepitant]] (Redirects: [[Fosaprepitant]], [[Emend]])
* [[Dexamethasone]]
* [[Granisetron]] (Redirects: [[Kytril]])
* [[Haloperidol]] (Redirects: [[Haldol]])
* [[Metoclopramide]] (Redirects: [[Reglan]])
* [[Ondansetron]] (Redirects: [[Zofran]])
* [[Prochlorperazine]] (Redirects: [[Compazine]])
* [[Promethazine]] (Redirects: [[Phenergan]])
* [[Propofol]]
* [[Scopolamine]] (Redirects: [[Hyoscine]])

=== Antifibrinolytics ===
* [[Tranexamic acid]] (Redirects: [[TXA]])

=== Antihistamines ===
* [[Diphenhydramine]] (Redirects: [[Benadryl]])
* [[Famotidine]] (Redirects: [[Pepcid]])

=== Antithrombotics ===
* Antiplatelet drugs
** [[Aspirin]]
** [[Clopidogrel]] (Redirects: [[Plavix]])
** [[Ticagrelor]] (Redirects: [[Brilinta]])
* Anticoagulants
** [[Apixaban]] (Redirects: [[Eliquis]])
** [[Argatroban]]
** [[Dabigatran]] (Redirects: [[Pradaxa]])
** [[Fondaparinux]]
** [[Heparin]]
** [[Low-molecular-weight heparin]] (Redirects: [[Enoxaparin]], [[Lovenox]], [[LMWH]])
** [[Rivaroxaban]] (Redirects: [[Xarelto]])
** [[Warfarin]] (Redirects: [[Coumadin]])
* Thrombolytics
** [[Tissue plasminogen activator]] (Redirects: [[Alteplase]], [[tPA]])
** [[Streptokinase]]

=== Anxiolytics ===
* [[Diazepam]]
* [[Lorazepam]]
* [[Midazolam]]

=== Benzodiazepines ===
* [[Diazepam]] (Redirects: [[Valium]])
* [[Flumazenil]]
* [[Lorazepam]] (Redirects: [[Ativan]])
* [[Midazolam]] (Redirects: [[Versed]])

=== [[Chronotropes]] ===
Redirects: [[Negative chronotropes]], [[Positive chronotropes]]
* Negative chronotropes
** [[Adenosine]]
** [[Beta blockers]]
*** [[Esmolol]]
*** [[Labetalol]]
*** [[Metoprolol]]
* Positive chronotropes
** [[Atropine]]
** [[Dobutamine]]
** [[Dopamine]]
** [[Ephedrine]]
** [[Epinephrine]]
** [[Glycopyrrolate]]
** [[Isoprenaline]]
** [[Milrinone]]
** [[Norepinephrine]]

* Electrolytes
** [[Calcium chloride]]
** [[Calcium gluconate]]
** [[Magnesium sulfate]]
** [[Potassium chloride]]

=== Diuretics ===

* [[Furosemide]]
* [[Mannitol]]

=== [[General anesthetics]] ===
* [[Inhalational anesthestics]] (Redirects: [[Volatile anesthetics]])
** [[Chloroethane]] (Redirects: [[Ethyl chloride]])
** [[Chloroform]]
** [[Cyclopropane]]
** [[Desflurane]] (Redirects: [[Suprane]])
** [[Diethyl ether]] (Redirects: [[Ether]])
** [[Enflurane]]
** [[Halothane]] (Redirects: [[Fluothane]])
** [[Isoflurane]] (Redirects: [[Forane]])
** [[Methoxyflurane]]
** [[Nitrous oxide]]
** [[Sevoflurane]] (Redirects: [[Ultane]])
** [[Xenon]]
* [[Intravenous anesthetics]]
** [[Etomidate]] (Redirects: [[Amidate]])
** [[Ketamine]] (Redirects: [[Esketamine]], [[Ketalar]])
** [[Methohexital]] (Redirects: [[Brevital]])
** [[Propofol]] (Redirects: [[Diprivan]])
** [[Thiopental]] (Redirects: [[Sodium pentothal]])

=== Imaging dyes ===
* [[Fluorescein]]
* [[Indocyanine green]]
* [[Methylene blue]] (Redirects: [[Methylthioninium chloride]])

=== [[Inodilators]] ===
* [[Dobutamine]]
* [[Milrinone]] (Redirects: [[Primacor]])

=== [[Inotropes]] ===
Redirects: [[Negative inotropes]], [[Positive inotropes]]
* Negative inotropes
** [[Beta blockers]]
* Positive inotropes
** [[Calcium chloride]]
** [[Calcium gluconate]]
** [[Dobutamine]]
** [[Dopamine]]
** [[Ephedrine]]
** [[Epinephrine]]
** [[Isoprenaline]]
** [[Milrinone]]
** [[Norepinephrine]]

=== [[Intravenous fluids]] ===
* [[Albumin]]
* [[Hetastarch]] (Redirects: [[Hydroxyethyl starch]])
* [[Intravenous sugar solution]] (Redirects: [[D5]], [[D50]], [[D5W]], [[D5NS]], [[D5LR]])
* [[Normal saline]] (Redirects: [[NS]])
* [[Lactated Ringer's]] (Redirects: [[LR]])
* [[Normosol]]
* [[Plasma-lyte]]
* [[Sodium bicarbonate]]

=== [[Local anesthetics]] ===
* [[Benzocaine]]
* [[Bupivacaine]] (Redirects: [[Marcaine]])
* [[Chloroprocaine]] (Redirects: [[Nesacaine]])
* [[Procaine]] (Redirects: [[Novocain]], [[Novocaine]])
* [[Lidocaine]] (Redirects: [[Xylocaine]])
* [[Mepivacaine]] (Redirects: [[Carbocaine]])
* [[Ropivacaine]] (Redirects: [[Naropin]])
* [[Tetracaine]]

=== [[Local anesthetic adjuvants]] ===
* [[Clonidine]]
* [[Epinephrine]]
* [[Fentanyl]]
* [[Hydromorphone]]
* [[Ketamine]]
* [[Midazolam]]
* [[Morphine]]
* [[Neostigmine]]
* [[Sufentanil]]
* [[Sodium bicarbonate]]

=== [[Neuromuscular blockers]] ===
* [[Cisatracurium]] (Redirects: [[Nimbex]])
* [[Mivacurium]]
* [[Rocuronium]] (Redirects: [[Zemuron]])
* [[Succinylcholine]] (Redirects: [[Anectine]])
* [[Vecuronium]]

=== [[Opioids]] ===
* [[Opioid analgesics]]
** Opium alkaloids and derivatives
*** [[Buprenorphine]] (Redirects: [[Subutex]])
*** [[Codeine]]
*** [[Hydrocodone]] (Redirects: [[Vicodin]])
*** [[Hydromorphone]] (Redirects: [[Dilaudid]])
*** [[Morphine]]
*** [[Oxycodone]] (Redirects: [[Oxycontin]], [[Roxicodone]])
** Synthetic opioids
*** [[Alfentanil]] (Redirects: [[Alfenta]])
*** [[Fentanyl]] (Redirects: [[Sublimaze]])
*** [[Methadone]]
*** [[Meperidine]] (Redirects: [[Demerol]], [[Pethidine]])
*** [[Remifentanil]] (Redirects: [[Ultiva]])
*** [[Sufentanil]] (Redirects: [[Sufenta]])
** [[Tramadol]] (Redirects: [[Ultram]])
* Opioid antagonists
** [[Naloxone]] (Redirects: [[Narcan]])
** [[Naltrexone]]
* [[Buprenorphine/naltrexone]] (Redirects: [[Suboxone]])

=== [[Sedative hypnotics]] ===
* [[Dexmedetomidine]]
* [[Etomidate]]
* [[Ketamine]]
* [[Methohexital]]
* [[Midazolam]]
* [[Propofol]]
* [[Thiopental]]

=== Steroids ===
* [[Dexamethasone]] (Redirects: [[Decadron]])
* [[Hydrocortisone]]

=== [[Uterotonics]] ===
* [[Carboprost]] (Redirects: [[Hemabate]])
* [[Methylergometrine]] (Redirects: [[Methergine]], [[Methylergonovine]])
* [[Misoprostol]] (Redirects: [[Cytotec]])
* [[Oxytocin]] (Redirects: [[Pitocin]])

=== [[Vasodilators]] ===
* Calcium channel blockers
** [[Clevidipine]] (Redirects: [[Cleviprex]])
** [[Nicardipine]] (Redirects: [[Cardene]])
** [[Nimodipine]] (Redirects: [[Nimotop]])
* Nitrovasodilators
** [[Nitric oxide]] (Redirects: [[NO]])
** [[Nitroglycerin]]
** [[Nitroprusside]] (Redirects: [[Nipride]], [[SNP]], [[Sodium nitroprusside]])
* Pulmonary vasodilators
** [[Nitric oxide]] (Redirects: [[NO]])
** [[Epoprostenol]] (Redirects: [[Flolan]], [[Prostacyclin]], [[Prostaglandin I2]])
* [[Dobutamine]]
* [[Fenoldopam]] (Redirects: [[Corlopam]])
* [[Hydralazine]]
* [[Milrinone]]
* [[Sildenafil]] (Redirects: [[Revatio]], [[Viagra]])

=== [[Vasoconstrictors]] ===
* [[Ephedrine]]
* [[Epinephrine]]
* [[Phenylephrine]]
* [[Norepinephrine]]
* [[Dopamine]]
* [[Vasopressin]] (Redirects: [[Vasostrict]])

=== Other drugs ===
* [[Octreotide]]

=[[:Category:Transfusion medicine|Transfusion medicine]]=
==[[:Category:Blood products|Blood products]]==
*[[Packed red blood cells|Packed red blood cells (pRBCs)]]
*[[Fresh frozen plasma|Fresh frozen plasma (FFP)]]
*[[Platelets]]
*[[Cryoprecipitate]]
*Whole blood
*Blood salvage ("Cell Saver")

=Procedures in anesthesia=
*[[Airway procedures]]
*[[Neuraxial anesthesia]]
*[[Regional anesthesia]]
*Vascular access procedures
**[[Arterial line]]
**Central line
***[[Central venous catheter|Central venous catheter (CVC)]]
***[[Introducer sheath|Introducer sheath (Cordis)]]
***[[Peripherally inserted central catheter|Peripherally inserted central catheter (PICC)]]
**[[Peripheral IV|Peripheral IV (PIV)]]
**Midline Catheter
**[[Microintroducer]]
**[[Rapid infusion catheter|Rapid infusion catheter (RIC)]]

=[[Subspecialties in anesthesia]]=
*[[Cardiothoracic anesthesia]]
*[[Critical care medicine]]
*[[Neuroanesthesia]]
*[[Obstetric anesthesia]]
*[[Pain medicine]]
*[[Pediatric anesthesia]]
*[[Pediatric cardiac anesthesia]]
*[[Perioperative medicine]]
*[[Regional anesthesia and acute pain]]
*[[Transplant anesthesia]]

Repair of tracheoesophageal fistula (TEF)

2023-08-16T11:07:38Z

Agfasman: created the page

Tracheoesophageal fistula (TEF) is a congenital anomaly seen in the neonatal period in which a patient's trachea and esophagus fail to septate properly. TEF occurs in approximately 1 in 3,000 live births<ref name=":0">{{Cite web|last=Morris|first=Michael|last2=Blewett|first2=Christopher|title=Tracheoesophageal Fistula|url=https://publications.aap.org/neoreviews/article/18/8/e472/91872/Tracheoesophageal-Fistula?autologincheck=redirected|url-status=live|access-date=2023-07-26|website=publications.aap.org|doi=10.1542/neo.18-8-e472}}</ref>. Prenatal ultrasound can show an absent gastric bubble and polyhydramnios. In the neonatal period, signs and symptoms of TEF include respiratory distress with feeding, regurgitation, and choking. Diagnosis is confirmed by failing to pass an orogastric tube, with radiography showing tube coiling in the upper airway, increased gastric and intestinal air, and possible pneumonitis<ref name=":1">{{Cite journal|last=Slater|first=Bethany J.|last2=Rothenberg|first2=Steven S.|date=2016-06|title=Tracheoesophageal fistula|url=https://pubmed.ncbi.nlm.nih.gov/27301604|journal=Seminars in Pediatric Surgery|volume=25|issue=3|pages=176–178|doi=10.1053/j.sempedsurg.2016.02.010|issn=1532-9453|pmid=27301604}}</ref>. Surgical repair is the only definitive therapy. Anesthesia concerns are primarily related to airway management.

== Overview ==

=== Fistula Types ===
TEF comes in five different anatomical configurations. The most common is a "Type C" fistula, seen in ~85% of patients, consisting of proximal esophageal atresia with a fistula between the trachea and the distal esophageal segment<ref>{{Cite journal|last=Lee|first=Sura|date=2018-02|title=Basic Knowledge of Tracheoesophageal Fistula and Esophageal Atresia|url=https://pubmed.ncbi.nlm.nih.gov/29373345|journal=Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses|volume=18|issue=1|pages=14–21|doi=10.1097/ANC.0000000000000464|issn=1536-0911|pmid=29373345}}</ref>. Other configurations include:

Type A: Esophageal atresia without any fistula connection between the trachea and esophagus.

Type B: Esophageal atresia with a fistula between the trachea and the proximal esophageal segment.

Type D: Esophageal atresia with two fistulae– one between the trachea and the proximal esophageal segment, and one between the trachea and the distal esophageal segment.

Type E: Fistula between the trachea and esophagus without esophageal atresia (also called an "H-Type Fistula").

The position of the fistula can have a significant impact on airway management.

=== VACTREL Association<ref name=":2">{{Cite journal|last=Solomon|first=Benjamin D.|last2=Baker|first2=Linda A.|last3=Bear|first3=Kelly A.|last4=Cunningham|first4=Bridget K.|last5=Giampietro|first5=Philip F.|last6=Hadigan|first6=Colleen|last7=Hadley|first7=Donald W.|last8=Harrison|first8=Steven|last9=Levitt|first9=Marc A.|last10=Niforatos|first10=Nickie|last11=Paul|first11=Scott M.|date=2014-03|title=An approach to the identification of anomalies and etiologies in neonates with identified or suspected VACTERL (vertebral defects, anal atresia, tracheo-esophageal fistula with esophageal atresia, cardiac anomalies, renal anomalies, and limb anomalies) association|url=https://pubmed.ncbi.nlm.nih.gov/24332453|journal=The Journal of Pediatrics|volume=164|issue=3|pages=451–457.e1|doi=10.1016/j.jpeds.2013.10.086|issn=1097-6833|pmc=3943871|pmid=24332453}}</ref> ===
When TEF is diagnosed, workup must also be initiated for associated congenital anomalies referred to as the "VACTERL" Association. Diagnosis requires the presence of at least two of the following conditions: Vertebral anomalies (seen in 60%-90% of VACTERL diagnoses), Anorectal malformations (55%-90%), Cardiac anomalies (40%-80%), TEF (50%-80%), Renal anomalies (50%-80%), and Limb anomalies (40%-55%). Presence or absence of cardiac anomalies, including cyanotic congenital heart defects, situs inversus, vascular anomalies or arrhythmias, has the biggest impact on overall survival and anesthetic management<ref>{{Cite journal|last=Spitz|first=Lewis|date=2007-05-11|title=Oesophageal atresia|url=https://pubmed.ncbi.nlm.nih.gov/17498283|journal=Orphanet Journal of Rare Diseases|volume=2|pages=24|doi=10.1186/1750-1172-2-24|issn=1750-1172|pmc=1884133|pmid=17498283}}</ref>.

=== Surgical procedure ===
Surgery can be performed via an open or thoracoscopic approach. Thoracoscopy avoids many of the complications of the open approach, such as development of scoliosis or shoulder glide weakness<ref>{{Cite journal|last=Rothenberg|first=S. S.|date=2013-05|title=Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula in neonates, first decade's experience: Thoracoscopic repair of EATEF|url=https://academic.oup.com/dote/article-lookup/doi/10.1111/dote.12054|journal=Diseases of the Esophagus|language=en|volume=26|issue=4|pages=359–364|doi=10.1111/dote.12054}}</ref>. Thoracoscopy has also been associated with longer operating times, but shorter time to extubation and shorter time to first enteral feeding, without significant difference in complication rates<ref>{{Cite journal|last=Yang|first=Yi-Fan|last2=Dong|first2=Rui|last3=Zheng|first3=Chao|last4=Jin|first4=Zhu|last5=Chen|first5=Gong|last6=Huang|first6=Yan-Lei|last7=Zheng|first7=Shan|date=2016-07|title=Outcomes of thoracoscopy versus thoracotomy for esophageal atresia with tracheoesophageal fistula repair: A PRISMA-compliant systematic review and meta-analysis|url=https://pubmed.ncbi.nlm.nih.gov/27472740|journal=Medicine|volume=95|issue=30|pages=e4428|doi=10.1097/MD.0000000000004428|issn=1536-5964|pmc=5265877|pmid=27472740}}</ref>. The major steps are the same for both approaches. The distal and proximal esophageal segments are identified, as well as the trachea and fistula. The azygos vein and vagus nerve are also identified, and care is taken to avoid damage to these structures. The fistula is clipped or suture ligated proximal to the trachea. Importantly, the fistula may not be divided following closure to prevent contracture of the connected esophageal segment. At this point, the proximal and distal esophageal segments are opened. A nasogastric tube is placed across them under direct visualization to guide the anastomosis and ensure patency<ref name=":1" />.

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|Review imaging prior to patient evaluation to confirm the fistula type. There are several options for intubation, including general endotracheal intubation, or intentional main stem intubation below the level of the fistula. Plan should be made based on the number of fistulae, whether they are proximal or distal, and relative position to the carina. Bronchoscopy may also be performed immediately prior to surgery<ref name=":1" />.
|-
|Cardiovascular
|VACTERL anomalies may be present, including cyanotic CHD, situs inversus, right sided aortic arch, arrhythmia, or others. These should be screened for prior to the procedure, and considered when making an anesthetic plan<ref name=":2" />.
|-
|Pulmonary
|Respiratory distress may be present to varying degrees. Most fistula types result in increased gastric air, increasing abdominal pressure and difficulty ventilating. If the patient is currently intubated, confirm vent settings, assess ETCO2, and get a VBG to determine adequacy of ventilation.
|-
|Gastrointestinal
|Confirming the fistula type by radiography is an important pre-operative step. This is typically done by attempting to pass an orogastric tube (commonly, a Repogle tube) and taking a chest and abdominal X-ray. Coiling of the tube in the proximal esophagus indicates the presence of atresia, while the presence or absence of air in the stomach and intestines.
|-
|Renal
|Renal anomalies may be seen as part of the VACTERL association. Preoperative chemistries should be evaluated.
|-
|Musculoskeletal
|Vertebral anomalies may be present in the VACTERL association. Cervical vertebral malformations, abnormal curvature, and tethered cord syndrome may be present, and should be considered prior to intubation.
|}

=== Labs and studies ===

* Chest and abdominal X-rays aid in diagnosis and can help identify fistula type as described above
* Echocardiography should be considered, but may not be necessary in the absence of abnormal cardiac exam findings<ref>{{Cite journal|last=Nasr|first=Ahmed|last2=McNamara|first2=Patrick J.|last3=Mertens|first3=Luc|last4=Levin|first4=David|last5=James|first5=Andrew|last6=Holtby|first6=Helen|last7=Langer|first7=Jacob C.|date=2010-05|title=Is routine preoperative 2-dimensional echocardiography necessary for infants with esophageal atresia, omphalocele, or anorectal malformations?|url=https://pubmed.ncbi.nlm.nih.gov/20438917|journal=Journal of Pediatric Surgery|volume=45|issue=5|pages=876–879|doi=10.1016/j.jpedsurg.2010.02.002|issn=1531-5037|pmid=20438917}}</ref>.
* CBC, CMP, and Blood Gasses should all be considered pre-op.

== Intraoperative management ==

=== Monitoring and access ===

* Blood Pressure: Invasive blood pressure monitoring may be indicated for patients with associated cardiac anomalies.
* Pulse Oximetry and EtCO2: Important for monitoring adequacy of ventilation.
* Telemetry Monitoring
* Temperature Monitoring
* PIVs

=== Induction<ref>{{Cite journal|last=Diaz|first=Laura K.|last2=Akpek|first2=Elif A.|last3=Dinavahi|first3=Radhika|last4=Andropoulos|first4=Dean B.|date=2005-10|title=Tracheoesophageal fistula and associated congenital heart disease: implications for anesthetic management and survival|url=https://pubmed.ncbi.nlm.nih.gov/16176315|journal=Paediatric Anaesthesia|volume=15|issue=10|pages=862–869|doi=10.1111/j.1460-9592.2005.01582.x|issn=1155-5645|pmid=16176315}}</ref><ref name=":3">{{Cite journal|last=Broemling|first=Natasha|last2=Campbell|first2=Fiona|date=2011-11|title=Anesthetic management of congenital tracheoesophageal fistula|url=https://pubmed.ncbi.nlm.nih.gov/20723095|journal=Paediatric Anaesthesia|volume=21|issue=11|pages=1092–1099|doi=10.1111/j.1460-9592.2010.03377.x|issn=1460-9592|pmid=20723095}}</ref> ===

* Inhalational inductions are typically used, favored for their hemodynamic stability.
* Propofol or Dexmedetomidine should be on hand, and may be used if rapid IV induction is needed.
* Muscle relaxing agents (eg. Rocuronium) may be used depending on the chosen airway management strategy.

=== Airway management ===
{| class="wikitable"
|+
! colspan="2" |Strategies for airway management (as described in Broemling and Campbell<ref name=":3" />)
|-
|Spontaneous Ventilation
|Positive pressure ventilation increases the risk of gastric insufflation and ventilatory compromise. Physiologic negative pressure ventilation lowers the risk of increasing airflow through the fistula. In patients with good pulmonary compliance or demonstrated easy masking without gastric distention, spontaneous ventilation may be tried, knowing standard intubation and PPV is a viable backup.
|-
|Main Stem Intubation and One-Lung Ventilation
|This method allows for collapse of the lung in the operative field during fistula ligation. The tube can often be retracted to the trachea following fistula ligation. Main stem intubation typically requires increased FiO2 and flow rates to maintain adequate oxygenation.
|-
|Distal-Fistula Intubation
|Intubation distal to the fistula can allow for bilateral ventilation with positive pressure for neonates with respiratory failure. Caution must be used to ensure the tube does not migrate into a main stem bronchus. Migration of the ETT into the fistula may also occur, and can have extremely morbid outcomes.
|-
|Fistula Occlusion
|Fistula occlusion via Fogarty catheter can also be considered, but is difficult to execute and may dislodge, occluding the central airways.
|}

=== Positioning ===
Positioning is lateral recumbent, typically with the right side elevated ~30º for thoracic access and proper positioning of the lung relative to the mediastinum<ref name=":1" />.

=== Maintenance and surgical considerations ===

* Inhaled agents are typically used for maintenance of anesthesia.
* Insufflation for thoracoscopy may lead to desaturations and decreased venous return. The patient should be converted to an open procedure in that case, with use of additional anesthetic and pain control as indicated. This may also indicate a need for neuromuscular blockade and positive pressure ventilation if not already in use.
* Following ligation of the fistula, positive pressure ventilation may be initiated if needed without concern for gastric distention.

=== Emergence ===

* Extubation depends on ventilatory needs post op, as well as concern for laryngomalacia or tracheomalacia, injury to the recurrent laryngeal nerve, or suspicion for other ventilatory complications. Patient may be transferred post op while still intubated<ref name=":3" />.

== Postoperative management ==

=== Disposition ===

* Patients may remain intubated following the case, and will need to be monitored in a Neonatal Intensive Care Unit as ventilatory support is weaned.
* Post-op enteral feeding may be administered through a trans-anastomotic nasogastric tube. This may shorten time on TPN<ref>{{Cite journal|last=Alabbad|first=Saleh I.|last2=Ryckman|first2=Jon|last3=Puligandla|first3=Pramod Shailendra|last4=Shaw|first4=Kenneth|last5=Nguyen|first5=Luong T.|last6=Laberge|first6=Jean-Martin|date=2009-05|title=Use of transanastomotic feeding tubes during esophageal atresia repair|url=https://pubmed.ncbi.nlm.nih.gov/19433166|journal=Journal of Pediatric Surgery|volume=44|issue=5|pages=902–905|doi=10.1016/j.jpedsurg.2009.01.027|issn=1531-5037|pmid=19433166}}</ref>, however subsequent reviews have found an increased risk of esophageal stricture and no significant reduction in anastomotic leak<ref>{{Cite journal|last=Wang|first=Chuan|last2=Feng|first2=Liwei|last3=Li|first3=Yanan|last4=Ji|first4=Yi|date=2018-12-12|title=What is the impact of the use of transanastomotic feeding tube on patients with esophageal atresia: a systematic review and meta-analysis|url=https://pubmed.ncbi.nlm.nih.gov/30541487|journal=BMC pediatrics|volume=18|issue=1|pages=385|doi=10.1186/s12887-018-1359-5|issn=1471-2431|pmc=6292097|pmid=30541487}}</ref>.

=== Pain management ===

* Opioid sparing techniques, such as regional anesthetics in the thorax, should be used with caution due to immature hepatic metabolism of these agents<ref name=":3" />.

=== Potential complications<ref>{{Cite journal|last=Lal|first=Dave R.|last2=Gadepalli|first2=Samir K.|last3=Downard|first3=Cynthia D.|last4=Ostlie|first4=Daniel J.|last5=Minneci|first5=Peter C.|last6=Swedler|first6=Ruth M.|last7=Chelius|first7=Thomas|last8=Cassidy|first8=Laura|last9=Rapp|first9=Cooper T.|last10=Deans|first10=Katherine J.|last11=Fallat|first11=Mary E.|date=2017-08|title=Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula|url=https://pubmed.ncbi.nlm.nih.gov/27993359|journal=Journal of Pediatric Surgery|volume=52|issue=8|pages=1245–1251|doi=10.1016/j.jpedsurg.2016.11.046|issn=1531-5037|pmid=27993359}}</ref> ===
Complications were noted in the cited review in as many as 62% of cases, with the most common being:

* Esophageal Stricture (42%)
* Anastomotic Leak (23%)
* Vocal Cord Injury (7%)
* Recurrent Fistula (5%)
* Anastomotic dehiscence (2%)

These may lead to additional consequences, such as chylothorax, empyema, pleural effusion, pneumothorax, and issues with growth and development<ref name=":0" />.

== References ==
<references />
[[Category:Surgical procedures]]

WikiAnesthesia - User contributions [en]

Repair of tracheoesophageal fistula (TEF)

Table of contents

Repair of tracheoesophageal fistula (TEF)