Anaesthetic implications of neonatal necrotizing enterocolitis

Abstract

A retrospective analysis of infants with necrotizing enterocolitis was done to evaluate the effects of preoperative abnormalities upon anaesthesia and morlality. Mortality was significantly increased in infants weighing less than 1500 grams (p < .001). Sixty-nine per cent of the infants had hyaline membrane disease and 35 per cent had platelet counts less than 50 • 109 cells/litre (50,000/ram3). Perioperative problems include peritonitis, sepsis, hypovolaemia, acidosis, and prematurity. Other ramifications of prematurity and anaesthesia are discussed.

Anaesthetic consideration for neonatal surgical emergencies

“…Continuous epidural injection provides analgesia, motor blockade without respiratory depression and may reduce the post-operative ventilation. [20] Isotonic fluid (10 mL/kg/h or more), colloid (albumin), sometimes dopamine infusion may be necessary. Warm irrigation fluid is administered.…”

“…[20] Symptoms are apparent from 2 nd to 6 th week of life. Neonates have severe projectile non-bilious vomiting with resultant hypochloraemic dehydration.…”

“…[5] Local infiltration technique can be used for the operation also. [20] Post-operatively wound infiltration, rectal acetaminophen and ketorolac are very useful. [5] Awake intubation is safer.…”

“…[20] NEC occurs as a result of bowel ischemia and hypotension due to poor cardiac output state, infection, and others, whereas intenstinal obstruction is due to congenital malformations, such as duodenal/jejuna atresia, Ladd band, rotations and others. These emergencies share the same clinical picture with abdominal distention, hypotension, coagulopathy, sepsis, dehydration and electrolyte imbalances.…”

“…Ketamine 4 mg/kg/h combined with fentanyl 10-30 μg/kg and a muscle relaxant can be administered. [20] Inhalational agent can be used with caution nitrous oxide is contraindicated. Blood, Fresh Frozen Plasma, platelet, dopamine, adrenaline in low dose may be necessary.…”