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Neonatal anaesthesia: Difference between revisions
→Gastroschisis and exomphalos (omphalocele)
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The neonate will require intubation and ventilation for surgery. Expect significant ongoing fluid and heat losses due to the exposed viscera. Peripheral intravenous access may be all that is required, but central venous pressure monitoring and an arterial line are useful to help guide fluid administration. Avoid the femoral vessels as there is a risk of decreased perfusion with the increased abdominal pressures. Placing the post-ductal oxygen saturation probe on either lower limb helps to give an indication if there is poor perfusion. Muscle relaxants will assist the surgeons in reducing the abdominal contents. Reduction of the bowel may cause abdominal compartment syndrome, diaphragmatic splinting and high ventilation pressures. If the intra gastric pressures are >20mmHg or the peak inspiratory pressures exceed 30cm H2O then a staged repair is indicated.<ref>Yaster M, Scherer TL, Stone MM et al. Prediction of successful primary closure of congenital abdominal wall defects using intraoperative measurements. J Pediatr Surg 1989; 24 1217–20.</ref> | The neonate will require intubation and ventilation for surgery. Expect significant ongoing fluid and heat losses due to the exposed viscera. Peripheral intravenous access may be all that is required, but central venous pressure monitoring and an arterial line are useful to help guide fluid administration. Avoid the femoral vessels as there is a risk of decreased perfusion with the increased abdominal pressures. Placing the post-ductal oxygen saturation probe on either lower limb helps to give an indication if there is poor perfusion. Muscle relaxants will assist the surgeons in reducing the abdominal contents. Reduction of the bowel may cause abdominal compartment syndrome, diaphragmatic splinting and high ventilation pressures. If the intra gastric pressures are >20mmHg or the peak inspiratory pressures exceed 30cm H2O then a staged repair is indicated.<ref>Yaster M, Scherer TL, Stone MM et al. Prediction of successful primary closure of congenital abdominal wall defects using intraoperative measurements. J Pediatr Surg 1989; 24 1217–20.</ref> | ||
Unless there is a very small defect the infant will require post- operative ventilation and a generous opioid-based anaesthetic technique can be used (fentanyl 10-20mcg.kg-1). These patients often require parenteral nutrition and a significant proportion present for further abdominal surgery. | Unless there is a very small defect the infant will require post- operative ventilation and a generous opioid-based anaesthetic technique can be used (fentanyl 10-20mcg.kg<sup>-1</sup>). These patients often require parenteral nutrition and a significant proportion present for further abdominal surgery. | ||
== CONCLUSION == | == CONCLUSION == | ||