TYK11

In the realm of neonatal pain, several landmark studies were done in the 1980s to determine the neonatal stress response. The addition of fentanyl to an anesthetic of nitrous oxide for PDA ligation was studied. Compared to nitrous oxide alone, the combination of fentanyl and nitrous oxide for PDA ligation had all of the following benefits EXCEPT:

A. Fewer cerebral hemorrhages

B. Less cardiovascular instability

C. Shorter duration of ventilation after surgery

D. Improved temperature stability during surgery

Answer

The answer is D. No evidence of temperature changes are reported. The endocrine stress response in neonatal patients is the same or greater than that of older children and adults. In the 1980s several studies demonstrated that the type of anaesthetic given could influence stress response and outcome. Anand et al. compared nitrous oxide to nitrous oxide and fentanyl in neonates having a ductal ligation. The fentanyl group had fewer cerebral hemorrhages, shorter ventilation after surgery and less cardiovascular instability. Anand et al also compared nitrous oxide to nitrous oxide and halothane and found neonates in the halothane group required less respiratory support and had less cardiovascular instability. There is also very strong evidence that neonates do indeed feel pain; painful stimuli increase cortical activation, and several clinical studies have demonstrated that neonates have better outcomes with adequate analgesia for painful non surgical procedures.

Notes

Anand, K. J., D. D. Hansen, and P. R. Hickey. "Hormonal-metabolic stress responses in neonates undergoing cardiac surgery." Anesthesiology 73.4 (1990): 661-670.[1]

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