Naloxone Reversal of Postoperative Apnea in a Premature Infant

Beilin, B.; Vatashsky, E; Aronson, H. B.; Weinstock, Marta

doi:10.1097/00000542-198509000-00014

Cited by 8 publications

(8 citation statements)

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“…Fifteen descriptive cases from eight publications were included for separate analysis 7,9,14,15,19‐22 . Most infants were male (80%).…”

Section: Resultsmentioning

confidence: 99%

“…The overall risk of bias of the case reports is low to moderate for all case studies, except for the case report by Bennett et al, which scored high due to lack of detailed information. 9,14,15,[19][20][21] Most case studies did not specify the type and volume of resuscitation fluids nor the duration of oxygen treatment or the presence or absence of hypothermia.…”

Section: Methodological Qualitymentioning

confidence: 99%

“…[23][24][25][26][27] The other studies were case studies, in which in total 15 descriptive cases of infants with IHPS and perioperative apnea were described. 9,14,15,[19][20][21][22] Six studies described preoperative apnea, three studies described postoperative apnea, and four studies described both. Detailed characteristics of the included studies are summarized in Table 1.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Fifteen descriptive cases from eight publications were included for separate analysis. 7,9,14,15,[19][20][21][22] Most infants were male (80%). Age at presentation differed from 10 to approximately 60 days.…”

Section: Descriptive Casesmentioning

confidence: 99%

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Perioperative apnea in infants with hypertrophic pyloric stenosis: A systematic review

Bunder

Wijk

Woensel

et al. 2020

Pediatric Anesthesia

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Background Infantile hypertrophic pyloric stenosis (IHPS) leads to excessive vomiting and metabolic alkalosis, which may subsequently cause apnea. Although it is generally assumed that metabolic derangements should be corrected prior to surgery to prevent apnea, the exact incidence of perioperative apneas in infants with IHPS and the association with metabolic alkalosis are unknown. We performed this systematic review to assess the incidence of apnea in infants with IHPS and to verify the possible association between apnea and metabolic alkalosis. Methods We searched MEDLINE, Embase, and Cochrane library to identify studies regarding infants with metabolic alkalosis, respiratory problems, and hypertrophic pyloric stenosis. We conducted a descriptive synthesis of the findings of the included studies. Results Thirteen studies were included for analysis. Six studies described preoperative apnea, three studies described postoperative apnea, and four studies described both. All studies were of low quality or had other research questions. We found an incidence of 27% of preoperative and 0.2%‐16% of postoperative apnea, respectively. None of the studies examined the association between apnea and metabolic alkalosis in infants with IHPS. Conclusions Infants with IHPS may have a risk to develop perioperative apnea. However, the incidence rates should be interpreted with caution because of the low quality and quantity of the studies. Therefore, further studies are required to determine the incidence of perioperative apnea in infants with IHPS. The precise underlying mechanism of apnea in these infants is still unknown, and the role of metabolic alkalosis should be further evaluated.

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“…Fifteen descriptive cases from eight publications were included for separate analysis 7,9,14,15,19‐22 . Most infants were male (80%).…”

Section: Resultsmentioning

confidence: 99%

Section: Methodological Qualitymentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Descriptive Casesmentioning

confidence: 99%

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Perioperative apnea in infants with hypertrophic pyloric stenosis: A systematic review

Bunder

Wijk

Woensel

et al. 2020

Pediatric Anesthesia

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“…A dose of 10 mg of caffeine per kg body weight given slowly intravenously after induction has been shown to eliminate postoperative apnoea and hypoxia in ex-preterms ( 4 4 weeks postgestational age) after general anaesthesia. Nalarone (7) and doxapram (8) have also been proven efficient in apnoea of prematurity and for postoperative apnoea but are generally considered of less value than methybranthines.…”

Section: Respiratory Stimulantsmentioning

confidence: 99%

Anaesthesia for ex–preterm infants

Nilsson¹

1993

Acta Anaesthesiol Scand

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An increasing number of preterm neonates survive, some of them with very short gestational age. Artificial ventilation is needed for about one forth of the heterogeneous preterm neonate group, oxygen therapy and continuous positive airway pressure for at least half of them. This treatment often results in lung disease (bronchopulmonary dysplasia BPD) with persistent need for oxygen therapy and sometimes prolonged ventilatory support. Secondary to this cardiac decompensation is common. Also without foregoing artificial ventilation and other intensive therapy a considerable number of preterm infants have complications related to their immaturity such as respiratory insufficiency and disturbanceof respiratory regulation, intracranial haemmorage, retrolental fibroplasia and feeding difficulties.The dominating indication for surgery is repair of inguinal hernia, reported to be present in 1555% of prematures (1) and ophthalologicaltreatnt. Careful perioperative anaesthetic and recovery care is of course neccesary for extensive surgery or other major treatment but also for minor surgical procedures. The anaesthetist will face several problems with the expreterm infant. This presentation is focused on the immatum control of breathing. For the ex-preterm having been through period of a neonatal intensive care therapy respiratory insufiiency and cardiac decompensarion and its consequences for anaesthesia must always be evaluated. These subjects are shortly depicted. For the low weight infant practical details such as airway control, temperature instability, drug and fluid administration also deserve special attention but are not dealt with in this presentation. Moreover the relatives very often need support having been through a long period of fear and uncertainty at the time when the child needs operation and anaesthesia. CONTROL OF BREATHINGApnea and periodic breathing is common in preterm neonates. The subject has recently been covered in two succinct reviews (2,3) with an extensive litterature survey to be consulted when specific references are not given in this text.The incidence of disturbance of respiratory control is inversly related to gestational and postconceptional age as is its consequences; hypoxia and bradycardia, eventually resulting in circulatory collapse. The interactive mechanisms behind the controlof breathing are not fully adapted to extrauterine life in the preterm infant, Prolonged ventilatory support and oxygen therapy appears to delay the maturing of this vital function. Hypoxia has an inhibitory effect on ventilation in the neonate and for a longer period in the expreterm baby. This may emanate from a protective fetal reflex inhibiting breathing movements during periods of reduced placental oxygen supply in order to spare unnecessary oxygen consumtion. Hypoxia in combination with little increase in ventilation in response to hypercarbia, especially with acidosis and/or hypothermia may result in prolonged apnoea. Anemia, commonly found in prematures, also contributes to an increased incidence of r...

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