Anaesthetic concerns in preterm and term neonates

Abstract

Anaesthesia for neonates is a composite of good knowledge of neonatal and transitional physiology combined with skill in airway maintenance and vascular access. When the newborn is a preterm, the complexities of management increase due to the small size and accompanying issues such as bronchopulmonary dysplasia and apnoea. World over, the number of survivors of preterm birth is on the increase. We searched Pubmed for “Anesthesia, apnea, neonatal, neonates, physiology, preterm, spinal anesthesia”, as well as cross references from review articles. These babies have a high incidence of conditions warranting surgery (e.g., tracheoesophaeal fistula, congenital diaphragmatic hernia, anorectal malformations, incarcerated hernia, necrotising enterocolitis). The possibility of neurodevelopmental harm by anaesthetics is currently the topic of active research. In parallel, advances in paediatric anaesthesia equipment, use of regional and neuraxial anaesthesia and availability of monitoring have steadily increased the safety of anaesthesia in these tiny patients.

Compassionate and standard operating procedure-based counseling and practice are essential in high-risk infantile anesthesia and managing death in eye surgery

“…Communication, protocols, and procedures are to be well defined and standardized so that everyone is on the same page. The professionals and equipment essential for such surgeries are a greater challenge to put these in place in an exclusive eye hospital,[ 3 ] but are not part of communication here. This paper specifically addresses the communication and counseling to bring parents into our medical-surgical team as partners in the challenge.…”

Regional anaesthesia in neonates: a narrative review

“…The spinal cord ends between L2 and L3 vertebrae in premature and in between L1 and L2 vertebrae in term infants whereas, the dural sac lies at S4 level at birth and reaches the S2 level by the end of the first year. 6 US assistance may be desirable for real-time visualisation of the dural sac, and conus medullaris. Spinal anaesthesia has a definite endpoint 6 and thus a shorter learning curve.…”

“…6 US assistance may be desirable for real-time visualisation of the dural sac, and conus medullaris. Spinal anaesthesia has a definite endpoint 6 and thus a shorter learning curve. It has a promise of reducing but not eliminating postoperative apnoea.…”

Management of total intravenous anaesthesia in preterm neonates with bronchopulmonary dysplasia

“…The authors of the article “Anaesthetic concerns in preterm and term neonates” have done an excellent job and deserve appraisal for their work;[ 1 ] we would, however, like to highlight the significance of understanding a possible alternative anaesthetic technique in this population. These patients may suffer from bronchopulmonary dysplasia (BPD), which can lead to a challenge when it comes to meeting respiratory goals.…”

“…Management of these neonates is challenging even for the most experienced physicians due to their small size and vulnerability to cardiovascular and respiratory events. [ 1 ] Adequate management of these patients is primarily based on avoiding nitrous oxide, providing good levels of oxygenation, consideration of perioperative bronchodilators and strict fluid control. [ 2 ] TIVA is a safe alternative in paediatric patients, reducing the risk that is seen with inhaled anaesthesia, thus optimising surgical conditions and reducing postoperative complications.…”