A Multidisciplinary Approach Toward the Anesthetic Management of a Patient With VACTERL Anomaly and Refractory...

Patients with vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities, collectively referred to as VACTERL association, present considerable anesthetic challenges due to the constellation of congenital anomalies that affect multiple organ systems. We report the case of a 27-year-old woman with a complex history of VACTERL association who underwent esophagogastroduodenoscopy (EGD) with Bravo capsule placement for evaluation of chronic nausea and refractory gastroesophageal reflux disease (GERD). Anesthetic considerations included a history of difficult airways, increased aspiration risk, and multiple drug allergies. Preoperative point-of-care gastric ultrasound (POCUS) was employed to confirm an empty stomach, facilitating the decision to proceed with monitored anesthesia care (MAC) while minimizing airway manipulation. This case underscores the importance of multidisciplinary coordination and the integration of bedside ultrasound in optimizing perioperative safety in high-risk syndromic patients.