Best practice & research. Clinical anaesthesiology
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Anaesthetic care during thoracic surgical procedures in neonates combines components of the knowledge bases of neonatal anaesthesia with those of thoracic anaesthesia. This chapter reviews the principles of anaesthesia during thoracic surgery in neonates including the pre-operative evaluation, anaesthetic induction techniques, maintenance anaesthesia and options for post-operative analgesia. ⋯ Techniques to provide OLV in the neonate and the principles of anaesthetic care during OLV are reviewed. Finally, specific scenarios of neonatal thoracic surgery are reviewed including anaesthetic care during: (1) laryngoscopy and rigid bronchoscopy, (2) thoracoscopy, (3) repair of tracheo-oesophageal fistula, (4) resection of congenital cystic adenomatoid malformation, and (5) treatment of congenital lobar emphysema.
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Best Pract Res Clin Anaesthesiol · Jun 2004
ReviewPain, opioid tolerance and sensitisation to nociception in the neonate.
Pain is commonplace in newborn infants. Opioid analgesics have become increasingly used to reduce different types of pain in neonates, including pain from surgery, medical procedures and chronic conditions. ⋯ These adverse effects can be minimised by utilising specific administration techniques and constant monitoring. Recent studies have demonstrated that untreated pain can have long-term effects on infant pain behaviours months beyond the events, thus, opioid analgesics may have a beneficial role that extends beyond the immediate painful event(s).
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Best Pract Res Clin Anaesthesiol · Jun 2004
ReviewRegional anaesthetic techniques for neonatal surgery: indications and selection of techniques.
The goal of neonatal care is to optimise the outcome of term and preterm infants with minimal suffering. Neonates are rare patients for the anaesthetist, therefore personal and even global experiences are limited. ⋯ With the exception of heel lancing, regional techniques are useful in all cases. However, a careful risk-benefit analysis is mandatory, especially when considering more invasive techniques such as epidural catheters.
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Best Pract Res Clin Anaesthesiol · Jun 2004
ReviewAnaesthetic considerations for the management of very low and extremely low birth weight infants.
The opportunities for very low birth weight infants (birth weight < 1500 g) and extremely low birth weight infants (birth weight < 1000 g) to undergo surgery are increasing. These infants are prone to prematurity-related morbidities including respiratory distress syndrome, intraventricular haemorrhage, periventricular leukomalacia, retinopathy of prematurity, patent ductus arteriosus and necrotising enterocolitis. ⋯ Key anaesthetic considerations are (i) inspired oxygen concentration that should be adjusted to avoid hyperoxia, (ii) haemodynamic parameters that should be kept stable and (iii) prevention of hypothermia by using adequate measures to keep the infants warm. These precautions must be continuously taken during the operation and the transport to and from the operating theatre.
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Best Pract Res Clin Anaesthesiol · Jun 2004
ReviewMajor abdominal surgery of the neonate: anaesthetic considerations.
The anaesthetic handling of neonates scheduled for major abdominal surgical procedures is one of the most demanding tasks that can confront an anaesthesiologist. This chapter will review the specific physiological characteristics of the newborn with relevance to anaesthesia and will also provide robust guidelines for the anaesthetic handling of the most frequent diagnoses that need major abdominal surgery during the neonatal period.