Anaesthetic implications of neonatal necrotizing enterocolitis

Neonatal perioperative resuscitation (NePOR) protocol-An update

Unexpected cardiac arrest in the perioperative period is a devastating complication. Owing to immaturity of organ systems, and presence of congenital malformations, morbidity and mortality are higher in neonates. There is abundant literature about early recognition and management of perioperative adverse events in children, but similar data and guidelines for surgical neonates is lacking. The current neonatal resuscitation guidelines cater to a newborn requiring resuscitation at the time of birth in the delivery room. The concerns in a newborn undergoing transition from intrauterine to extra uterine life is significantly different from a neonate undergoing surgery. This review highlights the causes and factors responsible for peri-arrest situations in neonates in the perioperative period, suggests preoperative surveillance for prevention of these conditions, and finally presents the resuscitation protocol of the surgical neonate. All these are comprehensively proposed as Neonatal Peri-operative Resuscitation (NePOR) protocol.

Anaesthetic consideration for neonatal surgical emergencies

A newborn requires constant vigilance, rapid recognition of the events and swift intervention during anaesthesia. The anaesthetic considerations in neonatal surgical emergencies are based on the physiological immaturity of various body systems, poor tolerance of the anaesthetic drugs, associated congenital disorders and considerations regarding the use of high concentration of oxygen. The main goal is for titration of anaesthetics to desired effects, while carefully monitoring of the cardiorespiratory status. The use of regional anaesthesia has shown to be safe and effective. Advancements in neonatology have resulted in the improvement of the survival of the premature and critically ill newborn babies. Most of the disorders previously considered as neonatal surgical emergencies in the past no longer require immediate surgery due to new technology and new methods of treating sick neonates. This article describes the common neonatal surgical emergencies and focuses on factors that affect the anaesthetic management of patients with these disorders.

Fundamentals of infant anaesthesia

Far from being more difficult, infants should be less difficult to anaesthetize . Generally the major organ systems, although not necessarily fully mature, are unsullied by smoking, alcohol consumption, atherosclerosis, assorted other pathology or simple wear and tear. Cardiac output is linked to heart rate and volume replacement, while oxygenation is controlled by lung expansion, FIO2 and perhaps PEEP. Admittedly, the rewards for poor technique are frightening and sudden, but the goal of this review has been to point out the anticipatory nature of paediatric anaesthesia, such that the actual anaesthetic becomes nearly an anti-climax. The rewards for this approach are usually brief procedures that frequently definitively repair isolated pathology, coupled with a sense of precise accomplishment that makes the planning and number- crunching worthwhile.