Neonatal anesthesia with limited resources

Abstract

Neonates are the most vulnerable age group in terms of anesthetic risk and perioperative mortality, especially in the developing world. Prematurity, malnutrition, delays in presentation, and sepsis contribute to this risk. Lack of healthcare workers, poorly maintained equipment, limited drug supplies, absence of postoperative intensive care, unreliable water supplies, or electricity are further contributory factors. Trained anesthesiologists with the skills required for pediatric and neonatal anesthesia as well as basic monitoring equipment such as pulse oximetry will go a long way to improve the unacceptably high anesthetic mortality.

Anesthesia for Children With Craniofacial Abnormalities in the Developing Countries

“…17 The WFSA has developed a pediatric fellowship in which groups of anesthesiologists are being trained in Chile, Rwanda, Tunisia, India, Kenya, and South Africa. 7,14 The goal of the WFSA fellowship is to expose these clinicians to pediatric scenarios they will eventually encounter in the own country with limited resources. At the end of their training, the physicians return to their home country with the ability to train more anesthesiologists in craniofacial abnormalities.…”

“…Other considerations include the long-term effects of surgery on a neonate, the occasional need for a neonatal ICU, or trained personnel in the recovery room, as well as long-term follow-up and management of these children. 14 …”

“…Limited staff, lack of training in complication management and postoperative pain control, constrained resources, and lack of monitoring and resuscitation equipment are to be considered. 4,11,12,14 The neonatal group brings additional challenges. Limitations include lack of not only personnel with adequate training but also specialty equipment.…”

“…Medications are scarce and medical supplies such as endotracheal tubes, facemasks, oral airways, nasal airways are frequently disinfected and reused because of limited resources. 4,5,10,11,14 Anesthesia machines are usually in short supply or unreliable and other techniques such as total intravenous anesthesia or regional anesthesia may be preferred. Challenges are also encountered in postoperative care.…”

Early events and lifelong change: looking beyond survival in the very young

“…Studies in neonatal anesthesia continue to focus on drugs, equipment, and techniques that look at short‐term outcomes. While this remains important particularly where resources are limited , we need to evaluate the more subtle longer term outcomes that have reference to our anesthetic practice. The current highly successful study comparing general anesthesia to awake regional anesthesia in preterm infants (the GAS collaboration) is a good example of where we should be heading in learning how we can optimize long‐term outcomes in neonates.…”