The former preterm infant and risk of post‐operative apnoea: recommendations for management

Abstract

The preterm infant presenting for anaesthesia during the first 6 months of life is a major anaesthetic challenge. One of the most serious post-operative complications is apnoea with or without bradycardia. For this review, we conducted a search of the current literature in order to formulate a set of evidence-based clinical guidelines to help clinicians in the management of the former preterm infant to avoid post-operative apnoea. Only a small number of patients have been enrolled into prospective, randomized, controlled studies. Based on the current literature, regional anaesthesia is strongly recommended, preferably neuraxial block, but general anaesthesia is also used and in this setting, opioids and muscle relaxants should be avoided. Infants with a post-conceptual age of less than 46 weeks should be admitted for continuous monitoring for at least 12 h post-operatively. In infants with a post-conceptual age (PCA) between 46 and 60 weeks, a careful assessment of the child is mandatory and 12 h of respiratory monitoring is recommended if the patient's history reveals episodes of apnoea at home, chronic lung disease (CLD), neurological disease or anaemia. The otherwise healthy infant could be scheduled for theatre as the first patient on the list and subsequently monitored in the post-anaesthetic care unit for 6 h. The risk of apnoea in former preterm infants can be further reduced by the administration of intravenous caffeine (10 mg/kg). All of these patients should be referred to a tertiary centre for anaesthesia and surgery.

Decreasing the need for mechanical ventilation after surgery forretinopathy of prematurity: sedoanalgesia vs. general anesthesia

“…Days on mechanical ventilation continuous positive airway pressure are indicators, too (21). All of these conditions affect the postoperative outcome of the babies (22). In our study, only anesthetic technique was found to have an effect on the need for postoperative mechanical ventilation.…”

Risk factors for spinal anesthesia in preterm infants undergoing inguinal hernia repair

“…Em consonância com nossos achados demonstrando que displasia broncopulmonar e leucomalácia periventricular foram os únicos fatores de risco preditores de desfecho desfavorável após raquianestesia, um estudo de revisão relatou que a apneia pós-operatória em recém-nascidos pré-termo esteve associada a displasia broncopulmonar, episódios de apneia no ambiente doméstico, doença neurológica e anemia 9 .…”

“…No entanto, orientações baseadas em evidências concluíram que recém-nascidos com história de apneia contínua, anemia, doença neurológica ou displasia broncopulmonar podem estar predispostos a apneia pós-operatória significativa até mesmo após raquianestesia, e devem ser considerados de risco 9 . Não foram investigadas outras complicações como alimentação tardia e hospitalização prolongada em recém-nascidos pré-termo submetidos a raquianestesia.…”

Assessment and Management of Inguinal Hernia in Infants

“…A recent meta-analysis concluded that former preterm infants undergoing general anesthesia who are less than 46 weeks' corrected gestational age should be observed for at least 12 hours postoperatively and that those who are between 46 and 60 weeks' corrected gestational age should receive more individualized care on the basis of the presence or absence of associated comorbidities. 40 To reduce the incidence of postoperative apnea, spinal, rather than general, anesthesia has been used for inguinal hernia repair in preterm infants. [41][42][43] Although some studies have been encouraging, none have been adequately powered.…”