Anaesthetic consideration for neonatal surgical emergencies

Abstract

A newborn requires constant vigilance, rapid recognition of the events and swift intervention during anaesthesia. The anaesthetic considerations in neonatal surgical emergencies are based on the physiological immaturity of various body systems, poor tolerance of the anaesthetic drugs, associated congenital disorders and considerations regarding the use of high concentration of oxygen. The main goal is for titration of anaesthetics to desired effects, while carefully monitoring of the cardiorespiratory status. The use of regional anaesthesia has shown to be safe and effective. Advancements in neonatology have resulted in the improvement of the survival of the premature and critically ill newborn babies. Most of the disorders previously considered as neonatal surgical emergencies in the past no longer require immediate surgery due to new technology and new methods of treating sick neonates. This article describes the common neonatal surgical emergencies and focuses on factors that affect the anaesthetic management of patients with these disorders.

Successful Management of Neonatal Tracheoesophageal Fistula with Epidural and General Anaesthesia

“…Similar to our case Markandeya et al [4] also observed excellent hemodynamic stability and intra and postoperative analgesia through caudal route for TEF repair under GA [4]. Use of combination of GA with epidural analgesia is well reported and found improved survival rates [1,5]. The major concern with GA is placing the distal end of ET tube beyond the fistula but above the carina and avoid gastric distension.…”

Anesthetic Management of a 9-day-old Neonate with Intestinal Evisceration due to Dog Bite

“…5 Nasogastric tube is essential for gastric decompression and remained on suction during induction and intubation to minimize the amount of gastric contents in the oropharynx. 2,6,7 Neonates coming for emergency surgery pose risk for anesthesia. Thorough understanding of physiological and pharmacological changes in neonates is important.…”

“…A newborn requires constant vigilance, rapid recognition of the adverse events, and swift intervention during anesthesia. 2 Important consideration is neonates with full stomach. There is risk of aspiration during induction and extubation.…”

Anesthetic Management of the Newborn Surgical Patient

“…It is imperative that the operating room be kept warm. Neonates, especially premature infants, are at high risk for heat loss due to an increased surface area to volume ratio when compared to older children and adults [26,27]. The need for invasive monitoring, including arterial and central venous catheter placement, is determined by the baseline medical condition of the patient and the extensiveness of the planned surgery.…”

“…Those patients presenting from inpatient hospital wards or the neonatal intensive care unit (NICU) with intravenous access in situ may undergo intravenous induction of general anesthesia [27].…”