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Continuing Education in Anaesthesia, Critical Care & Pain Advance Access originally published online on April 24, 2009
Continuing Education in Anaesthesia, Critical Care & Pain 2009 9(3):73-77; doi:10.1093/bjaceaccp/mkp010
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

The prematurely born infant and anaesthesia

Kawshala Peiris, MBChB FRCA
Specialist Registrar in Anaesthesia
University Hospitals of Leicester
Leicester Royal Infirmary
Leicester LE1 5WW
UK

David Fell, MBChB FRCA
Consultant Paediatric Anaesthetist
University Hospitals of Leicester
Leicester Royal Infirmary
Leicester LE1 5WW
UK
Tel: +44 116 258 6474
Fax: +44 116 258 6261
E-mail: felldavid@gmail.com (for correspondence)

The first 150 words of the full text of this article appear below.


Key points

During anaesthesia in the premature infant, provision of a thermoneutral ambient temperature is essential to prevent excessive heat loss.
High airway pressures and pulmonary hypertension can lead to reversion to the fetal circulation with right-to-left shunting.
Apnoea tolerance is greatly reduced in small infants and the use of classical rapid sequence induction has been questioned.
Acetaminophen and regional anaesthetic techniques must be utilized fully to reduce opioid usage.
Newer volatile agents with caudal analgesia can be used successfully for inguinal herniotomy in ex-premature babies.

 

One in 13 babies in the UK (50 000 per annum) is born prematurely.1 Although advances in neonatal intensive care have improved survival, mortality is still 42 per 1000 live births compared with 1.8 per 1000 in term babies.1 However, survivors can have a host of complications related to the underdeveloped organ systems and may present for a variety of surgical procedures (Table 1. . . [Full Text of this Article]


   Physiological considerations
 
Respiratory system

Control of respiration and apnoea

Cardiovascular system

Haematology

Renal function

Temperature regulation

Glucose homeostasis

Gastrointestinal system

Nervous system


   Pre-anaesthetic assessment
 

   Intraoperative management
 
Operating theatre and equipment

Monitoring

Anaesthesia

Analgesia

Intraoperative fluid management


   The ex-premature surgical baby
 

   Conclusion
 

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