Since publication of the first edition in 2015, neonatal anesthesia and surgery have advanced at lightning speed with many new developments, hence the need to update several essential topics. These include our understanding of neonatal apoptosis, the ever-increasing use of regional anesthesia in neonates, pharmacology of drugs in neonates, the delivery of anesthesia outside the operating room, neonatal resuscitation/guidelines, and perinatal complexities such as the EXIT procedure together with the fundamental principles of developmental physiology, airway management and ventilation as well as perioperative complications and ethical considerations that are unique to this age group.
This comprehensive and well-illustrated book is led by Dr. Jerrold Lerman who brings four decades of research, publication and clinical experience in pediatric and neonatal anesthesia. He has amassed a team of recognized international experts in neonatal anesthesia, surgery, and intensive care to share their knowledge in managing neonates for the challenges they face both within and without the surgical suites. Neonatal Anesthesia, the 2nd edition, is the quintessential clinical reference for perioperative care of these small patients that should be read by trainees as well as experienced clinicians and is certain to become an invaluable resource for every anesthetic and critical care department that serves children.
Reviews from the 1st edition:
“Lerman’s book stands alone as an up-to-date text dedicated exclusively to the practice of anesthesia in neonates … . The text covers its subject matter in extraordinary breadth and depth. … Throughout the book there are illustrative and clinically relevant diagrams, nicely supporting and summarizing relevant text for the more visual learner. … Neonatal Anesthesia is a sophisticated but approachable text that offers its readers theory-based practical approaches to understanding and managing anesthesia in our youngest, most fragile patient population.” (Stephanie A. Black and Lynne G. Maxwell, Anesthesiology, Vol. 125 (3), 2016)“It is a long-awaited contribution to the literature, filling a gap of over a decade without a neonatal anaesthesia textbook. … textbook should hold an essential and required spot on the bookshelf of any anaesthetist or critical care physician who cares for neonates. … The reference lists are comprehensive and exhaustive. Dr Lerman should be commended for finally presenting the anaesthesia community worldwide with this textbook, which will be able to stand on its own, probably for the next decade.” (K. P. Mason, British Journal of Anaesthesia, Vol. 116 (4), 2016)“This book covers in 400-plus pages and 17 chapters most of what is known about the neonatal airway, physiology, drugs and anesthetics, with separate chapters on each subcategory of neonatal anesthesia. … Certainly pediatric surgeons, anesthesiologists who only occasionally care for children, students, residents, and fellows will appreciate this book. … This is a large book on a narrow topic that has increasing relevance to the field of current pediatric practice. It is well written, well illustrated, and highly useful.” (Robert M. Arensman, Doody’s Book Reviews, April, 2015)
“The book has many outstanding chapters that have been thoughtfully crafted by leading researchers in specific fields. … this book is an essential addition to any pediatric anesthesiology library in any organization that provides care to neonates. This book is an excellent resource, not only for anesthesiologists at every level of training and expertise but also for other professionals who provide postoperative care, administer sedative drugs, control the airway, and undertake procedures in newborn infants.” (Carolyne Montgomery and J. Mark Ansermino, Canadian Journal of Anesthesia, Vol. 62, 2015)
Author(s): Jerrold Lerman
Edition: 2
Publisher: Springer
Year: 2023
Language: English
Pages: 652
City: Cham
Foreword
Acknowledgments
Contents
Contributors
1: The History of Neonatal Anesthesia
Prelude
Early Times
The Twentieth Century
Endotracheal Intubation of Neonates
Neuromuscular Blocking Drugs
Anesthesia Circuits and Controlled Ventilation
Monitoring
Intraoperative Temperature Control
Neonatal Anesthesia: Some Landmark Procedures and Their Development
Repair of Esophageal Atresia and Tracheoesophageal Fistula
Congenital Diaphragmatic Hernia
Abdominal Wall Defects
Neonatal Cardiovascular Surgery
Open Heart Surgery
Regional Analgesia
Minimally Invasive Neonatal Surgery
Ex Utero Intrapartum Treatment: “The EXIT Procedure”
Regionalization of Neonatal Services
Research in Neonatal Anesthesia
Ethical Considerations and Infant Anesthesia
References
2: Physiology and Development of the Term and Preterm Neonate
Cardiovascular Function
The Transitional Circulation
The Placenta: In Utero Function and Cord Clamping
Myocardial Development
Myocardial Compliance: Extracellular Matrix/Cytoskeleton
Adrenergic Function
The Preterm Infant
Clinical Significance and Summary
Central Nervous System Function
Normal Development of the Central Nervous System
Age-Related Patterns of Injury
Vulnerable Cell Populations: The Preterm Infant
Vulnerable Cell Populations: The Term Infant
Congenital Heart Disease
Summary
Autoregulation of Cerebral Blood Flow
Cerebral White Matter Injury
Germinal Matrix–Intraventricular Hemorrhage
Cerebellar Injury
Clinical Significance and Summary
The Pulmonary System
Embryology
The Embryonic Stage (0–7 Weeks’ Gestational Age)
Pseudoglandular Stage (7–17 Weeks’ Gestational Age)
Canalicular Stage (17–27 Weeks)
Saccular Phase (28–36 Weeks’ Gestation)
Alveolar Phase (36 Weeks’ Gestation Until ~2–3 Years)
Postnatal Development of the Lung
Airway Anatomy
Anatomy of Chest Wall and Mechanics of Breathing
Functional Residual Capacity
Pulmonary Function Testing
Pulmonary Surfactant
Respiratory Distress Syndrome (RDS)
Oxygen Toxicity
Control of Ventilation
Apnea of the Newborn
Hepatic Function
Anatomy
In Utero Development
Early Postnatal Hepatic Function: Anatomy
Early Postnatal Hepatic Function: Synthesis
Early Postnatal Hepatic Function: Metabolism
Early Postnatal Hepatic Function: Common Neonatal Hepatic Disorders and Hemorrhagic Disease of the Newborn
Early Postnatal Hepatic Function: Common Neonatal Hepatic Disorders, Jaundice, and Hyperbilirubinemia
Clinical Significance and Summary
Renal Function (also See Chap. 8
Developmental Changes in Distribution of Total Body Water
GFR and Blood Flow
Renal Tubular Function
Development of Sodium-Driven Transport Function
Renin–Angiotensin System
Clinical Significance and Summary
References
3: Anesthesia and Ancillary Drugs and the Neonate
Introduction
Disentangling Pharmacokinetic Covariates in Neonates
Size
Maturation
Organ Function
Neonatal Pharmacokinetic Differences
Absorption
Distribution
Body Composition
Plasma Proteins
Regional Blood Flows
Blood–Brain Barrier (BBB)
Elimination
Hepatic Metabolic Clearance
Extrahepatic Routes of Metabolic Clearance
Pulmonary Elimination
Renal Elimination
Neonatal Pharmacodynamic Differences
Pharmacodynamic Measures
Induction Agents
Propofol
Mechanism
Pharmacodynamics
Pharmacokinetics
Adverse Effects
Thiopentone
Mechanism
Pharmacodynamics
Pharmacokinetics
Adverse Effects
Ketamine
Mechanism of Action
Pharmacodynamics
Pharmacokinetics
Adverse Effects
Inhalation Agents
Physicochemical Properties
Pharmacokinetics
Ventilation
Cardiac Output
Induction
Control of Anesthetic Depth
Shunts
Metabolism
Emergence
Pharmacodynamics
Central Nervous System
Cardiovascular System
Respiratory System
Renal
Hepatic
Clinical Effects
Induction Techniques
Central Neuroexcitation
Emergence
Emergence Delirium
Neuromuscular Junction
Malignant Hyperthermia (MH)
Stability
Analgesic Drugs
Acetaminophen (Paracetamol)
Mechanism of Action
Analgesic Pharmacodynamics
Pharmacokinetics
Adverse Effects
Nonsteroidal Anti-Inflammatory Drugs
Mechanism of Action
Pharmacodynamics
Pharmacokinetics
Drug Interactions
Adverse Effects
Opioid Analgesic Drugs
Morphine
Pharmacodynamics
Pharmacokinetics
Adverse Effects
Fentanyl
Pharmacodynamics
Pharmacokinetics
Adverse Effects
Remifentanil
Pharmacodynamics
Pharmacokinetics
Adverse Effects
Alfentanil
Sufentanil
Codeine
Meperidine (Pethidine)
Methadone
Sedatives
Benzodiazepines
Mechanism of Action
Pharmacodynamics
Pharmacokinetics
Adverse Effects
Alpha-2 agonists
Clonidine
Pharmacodynamics
Pharmacokinetics
Dexmedetomidine
Pharmacodynamics
Pharmacokinetics
Adverse Effects
Local Anesthetic Agents
Mechanism of Action
Pharmacodynamics
Pharmacokinetics
Adverse Effects
Neuromuscular Blocking Drugs
Neonatal Physiology
Pharmacodynamics
Pharmacokinetics
Antagonism of Neuromuscular Blockade
Adverse Effects
Anticholinergic Drugs
Atropine
Scopolomine
Glycopyrrolate
Adverse Effects
References
4: The Selection of Anesthesia Techniques for the Neonate
Part 1. General Principles and Aims of Anesthesia in the Neonate
First Objective: To Provide Optimal Conditions for Surgery and Maintain Homeostasis.
Second Objective: To Avoid the Storage of Unpleasant Implicit Memories
Third Objective: To Ensure That the Techniques Employed Minimize the Risk of Cerebral Damage (Hypoxic/Ischemic, metabolic, or neurotoxic)
Cerebral Hypoxia/Ischaemia
Metabolic, Neurotoxic, and Other Potential Causes of Cerebral Damage.
Part 2. Techniques of Anesthesia
Spinal Anesthesia
Induction of General Anesthesia for Elective Surgery
Inhalational Induction
Use of Opioid Drugs to Facilitate Anesthesia Induction
Intravenous Induction
Other Issues During Anesthetic Induction
Muscle Relaxants for Tracheal Intubation
Nitrous Oxide
Tracheal Intubation: Oral or Nasal Route?
Rapid Sequence Induction for General Anesthesia
Preoxygenation
Gastric Emptying
Cricoid Pressure
Mask Ventilation
Anesthetic Agents for RSI
Maintenance of Anesthesia
Hypnosis
Analgesia
Muscle Relaxants
Conclusion
References
5: Airway Management
Upper Airway
Anatomy
Reflexes
Airway Management
Anesthesia
Preanesthetic Assessment
Preoperative Preparation
Airway Management and Equipment
Face Mask Ventilation
Laryngeal Mask Airways and Supraglottic Devices
Laryngoscopy and Airway Instrumentation
Orotracheal Intubation
Nasotracheal Intubation
Selection of Tracheal Tubes
Uncuffed Versus Cuffed Tracheal Tubes
Assessing Tracheal Tube Size
Positioning the Tip
Rapid Sequence Intubation
Managing the Difficult Airway
Managing the Airway in the Ex Utero Intrapartum Treatment (EXIT) Procedure (See Chap. 14)
References
6: Neonatal Ventilation Strategies and Their Practical Application
Respiratory System
Ventilation Modes
Pressure-Controlled Ventilation
Volume-Controlled Ventilation
Volume-Targeted Ventilation
High-Frequency Ventilation
Continuous Positive Airway Pressure and Noninvasive Ventilation
Nasal High-Flow Oxygenation
Application of Ventilation Modes in the Operating Theatre
Ventilation Strategy in the Operating Theatre
Monitoring of Ventilation
Conclusion
References
7: Perioperative Monitoring: Methods, Implementation, and Interpretation
Introduction
Cardiorespiratory Monitoring
Precordial Stethoscope
Arterial Hemoglobin Oxygen Saturation—Pulse Oximetry
Pulse Oximetry Use in Clinical Practice
Clinical Application of Pulse Oximetry
Electrocardiography (ECG)
Advanced Pulse CO-Oximetry and Oxygen Reserve Index (ORI)
Oxygen Reserve Index (ORI)
Inspired and Expired Gas Analysis
Sidestream Capnography
Mainstream Capnography
Transcutaneous Carbon Dioxide Monitoring (tcpCO2)
Apnea Monitors
Respiratory Volume Monitor (RVM)
Pulmonary Mechanic Monitors
Systemic Blood Pressure Monitoring
Noninvasive Blood Pressure (NIBP)
Invasive Blood Pressure
Definition of Hypotension
Central Venous Pressure Monitoring
Cannulation of the Internal Jugular Vein
Cannulating the Brachiocephalic Vein (BCV)
Central Venous Access: General Principles
The Nervous System
EEG and Amplitude-Integrated EEG (aEEG)
Near-Infrared Spectroscopy
Transcranial Doppler
Neurophysiological Monitors
Neuromuscular Junction Monitoring
Temperature Monitoring
Body Temperature Monitoring (see Chap. 8)
Monitoring Blood Glucose
Renal Function: Monitoring Urine Output
References
8: Metabolic Care of the Preterm and Term Infants, Including Control of Body Temperature
Neonatal Body Water Distribution and Metabolism
Postnatal Changes in Hypothalamic, Endocrine, and Renal Physiology
Hypothalamic–Pituitary–Adrenal Axis
Renin–Angiotensin–Aldosterone
Atrial Natriuretic Peptides (ANPs)
Antidiuretic Hormone
Neonatal Renal Function
Renal Blood Flow (RBF)
Glomerular Filtration Rate (GFR)
Tubular Function
Aquaporin Peptides
Maintenance Fluid Therapy
Water Requirement
Sodium and Electrolyte Requirements
Glucose
Endocrine Response at Birth
Hypoglycemia
Hyperglycemia
Enteral Nutrition (Trophic Feeding or Minimal Enteral Nutrition)
Minimal or Small Volume Enteral Nutrition (Trophic Feeding)
Normal Enteral Feeds
Total Parenteral Nutrition
Fasting and Preoperative Oral Fluids
Gastrointestinal Ontogeny
Gastric Fluid pH and Volume
Gastric Emptying
The Ideal Intraoperative Maintenance Fluid
Hyponatremia
Intravenous Solutions
Glucose-Containing Solutions
Perioperative Fluid Management
General Principles
Perioperative Steroids
Emergency Surgery
Maintenance Fluids
The Myth of the Third Space
Replacement of Intraoperative Losses
Intraoperative Hypotension
Colloids
Albumin
Nonprotein Colloids
Transfusion Triggers
Postoperative Fluid Maintenance
Postoperative Metabolic Needs
Special Cases: Cardiac Surgery
Temperature Homeostasis
Brown Adipose Tissue (BAT)
Normothermia and Hypothermia
Prevention of Hypothermia in Infants Receiving Anesthesia
References
9: General and Thoracoabdominal Surgery Including Management of Conjoined Twins
Introduction
General Considerations
Preoperative Assessment
History and Examination
Investigations
Logistical Issues
Emergency Status
Surgery in the NICU
Team Brief and Preparing the Theater
Conduct of Anesthesia
Monitoring
Induction
Vascular Access
Temperature Monitoring and Warming
Positioning
Fluid Management
Deficit
Maintenance Requirements
Perioperative Losses
Glucose
Transfusions
Platelets and Blood Products
Point of Care Testing
Minimally Invasive Surgery in Neonates
Physiological Effects of Laparoscopic Surgery
One-Lung Ventilation
Postoperative Care
Specific Conditions
Congenital Thoracic Malformations
Congenital Cystic Adenomatoid Malformation (CCAM)
Classification
Diagnosis
Postnatal Management
Surgical Considerations
Lung Sequestration
Classification
Diagnosis
Management
Surgical Considerations
Congenital Lobar Emphysema (CLE)
Diagnosis
Management
Anesthetic Implications for the Management of Congenital Thoracic Malformations
Esophageal Atresia/Tracheoesophageal Fistula
Classification
Diagnosis
Risk Stratification
Medical Management
Surgical Considerations
Anesthetic Considerations
Congenital Diaphragmatic Hernia
Embryology
Diagnosis
Outcomes
Antenatal Treatment
Medical Management
Surgical Considerations
Anesthetic Considerations
Abdominal Surgery
Inguinal Hernia
Pathophysiology
Diagnosis
Surgical Management
Anesthetic Management
Pyloric Stenosis
Diagnosis
Medical Management
Surgical Management
Anesthetic Considerations
Intestinal Atresias
Pyloric Atresia
Duodenal Atresia
Embryology
Diagnosis
Management
Outcomes
Surgical Considerations
Anesthetic Considerations
Jejunal/Ileal Atresia
Embryology
Diagnosis
Outcomes
Medical Management
Surgical Considerations
Anesthetic Considerations
Colonic Atresia
Diagnosis
Management
Surgical Considerations
Meconium Ileus
Diagnosis
Outcomes
Management
Surgical Considerations
Anesthetic Considerations
Malrotation and Volvulus
Embryology
Diagnosis
Outcomes
Management
Surgical Considerations
Anesthetic Considerations
Hirschsprung’s Disease
Embryology
Genetics
Diagnosis
Management
Surgical Procedures
Outcomes
Surgical Considerations
Anesthetic Considerations
Anorectal Anomalies
Embryology
Classification
Diagnosis
Outcomes
Management
Surgical Considerations
Anesthetic Considerations
Cloaca
Diagnosis
Management
Outcomes
Surgical Considerations
Abdominal Wall Defects
Gastroschisis
Pathophysiology
Diagnosis
Management
Outcomes
Surgical Considerations
Anesthetic Considerations
Exomphalos (Omphalocele)
Pathophysiology
Diagnosis
Outcomes
Management
Surgical Considerations
Anesthetic Considerations
Bladder Exstrophy/Cloacal Exstrophy
Outcomes
Management
Surgical Considerations
Anesthetic Considerations
Posterior Urethral Valves
Diagnosis
Management
Anesthetic Considerations
Sacrococcygeal Teratoma
Diagnosis
Management
Outcomes
Surgical Considerations
Anesthetic Considerations
Biliary Atresia
Classification
Diagnosis
Management
Surgical Approach
Anesthetic Considerations
Necrotizing Enterocolitis
Pathogenesis
Diagnosis
Outcomes
Management
Surgical Approach
Anesthetic Considerations
Conjoined Twins
Introduction
Epidemiology
Presentation
Management
Anesthesia Issues
Logistics
Airway
Vascular Access and Blood Loss
Preoperatively Assessment
Theater Setup
Conduct of Anesthesia
Induction
Airway
Lines
Monitoring
Fluids and Blood
Antibiotics
Inotropes and Resuscitation
Surgical Considerations
Postoperative Care
Summary
References
10: Neurosurgery and Ophthalmology
Introduction
Development of the Central Nervous and Visual System
Embryology
Cerebrovascular Physiology
Anatomy of the CNS and Eye
Cranium
Spine
Eye
Neurosurgery
Congenital Anomalies
Cranial Dysraphism
Spinal Dysraphisms
Anesthetic Management
Preanesthetic Evaluation
Intraoperative Management
Postoperative Management
Hydrocephalus
Anesthetic Management
Tumors
Anesthetic Management
Vascular Anomalies
Perinatal Stroke
Vein of Galen Malformation
Preoperative Management
Intraoperative Management
Postoperative Management
Ophthalmology
Congenital Ophthalmologic Lesions
Acquired Lesions
Retinopathy of Prematurity
Trauma
Summary
References
11: Cardiac Surgery
Introduction
Cardiovascular Physiology
Types of Circulation
Fetal Circulation
The Transitional Circulation
Postnatal Circulation
Cardiac Output and Distribution of Blood Flow
Developmental Aspects of the Myocardium
Epidemiology of Congenital Heart Disease
Clinical Presentation and Diagnosis of Congenital Heart Disease in the Neonate
Classification of Congenital Heart Disease
Congenital Cardiovascular Anomalies of the Neonate: Anatomy, Pathophysiology, and Management, with Anesthetic Considerations
Patent Ductus Arteriosus
Anatomic Features
Pathophysiology
Management
Anesthetic Considerations
Specific Issues
Coarctation of the Aorta
Anatomic Features
Pathophysiology
Management
Anesthetic Considerations
Specific Issues
d-Transposition of the Great Arteries
Anatomic Features
Pathophysiology
Management
Anesthetic Considerations
Specific Issues
Tetralogy of Fallot
Anatomic Features
Pathophysiology
Management
Anesthetic Considerations
Specific Issues
Total Anomalous Pulmonary Venous Return
Anatomic Features
Pathophysiology
Management
Anesthetic Considerations
Specific Issues
Truncus Arteriosus
Anatomic Features
Pathophysiology
Management
Anesthetic Considerations
Specific Issues
Critical Aortic Stenosis
Anatomic Features
Pathophysiology
Management
Anesthetic Considerations
Specific Issues
Hypoplastic Left Heart Syndrome
Anatomic Features
Pathophysiology
Management
Anesthetic Considerations
Specific Issues
Interrupted Aortic Arch
Anatomic Features
Pathophysiology
Management
Anesthetic Considerations
Specific Issues
Critical Pulmonary Stenosis and Pulmonary Atresia with Intact Ventricular Septum
Anatomic Features
Pathophysiology
Management
Anesthetic Considerations
Specific Issues
Aortopulmonary Window
Anatomic Features
Pathophysiology
Management
Anesthetic Considerations
Specific Issues
Ebstein Anomaly
Anatomic Features
Pathophysiology
Management
Anesthetic Considerations
Specific Issues
Preoperative Assessment of the Neonate with Congenital Heart Disease
History and Physical Examination
Ancillary Studies and Laboratory Data
Informed Consent
Fasting Period
Perioperative Considerations in the Neonate Undergoing Cardiac Surgery
Transport to the Operating Room
Premedication
Intravenous Access
Availability of Emergency Medications
Physiologic Monitoring
Electrocardiography
Pulse Oximetry
Capnography
Temperature
Arterial Blood Pressure
Noninvasive Monitoring
Indwelling Arterial Monitoring
Sites for Invasive Monitoring
Cutdown for Arterial Cannulation
Central Venous Pressure Monitoring
Ultrasound Guidance
Percutaneous Sites for Central Venous Access
Direct Transthoracic Pressure Monitoring
Urinary Output Measurements
Transesophageal Echocardiography
Neurologic Monitoring
Near-Infrared Spectroscopy
Transcranial Doppler Ultrasound
Intraoperative Management of the Neonate Undergoing Cardiac Surgery
Induction of Anesthesia
Maintenance of Anesthesia
Cardiopulmonary Bypass in the Neonate
Pre-bypass Period
Perfusion Equipment, Tubing, Circuits, and Bypass Prime
Heart-Lung Machine [(Pump]
Heat Exchanger Unit
Membrane Oxygenator
Arterial Filter
Cannulas and Tubing
Venous Reservoir
Air/Oxygen Blender, Carbon Dioxide Tank, High−/Low-Flow Meter
Cardioplegia Circuit
Blood Hemoconcentrator
Venous Saturation and Hematocrit Monitor
Activated Clotting Time Machine
Arterial Blood Gas Machine
Cell Saver
Miniaturization of Bypass Circuit
Pump Prime
Stages of Cardiopulmonary Bypass
Anticoagulation
Cannulation and Initiation of Cardiopulmonary Bypass
Cooling and Temperature Management
Aortic Cross-Clamping and Myocardial Protection
Release of Aortic Clamp and Myocardial Reperfusion
Separation from CPB, Reversal of Anticoagulation, and Removal of Cannulas
Transport to the Intensive Care Unit
Special Cardiopulmonary Bypass Techniques: Deep Hypothermic Circulatory Arrest, Selective Antegrade Cerebral Perfusion, and Others
Unique Aspects of Neonatal Cardiopulmonary Bypass and Differences From the Adult
Effects of Cardiopulmonary Bypass and Related Strategies
Systemic Inflammatory Response Syndrome
Effects on Bleeding and Coagulation
Neurologic Effects
Pulmonary Effects
Myocardial Effects
Renal and Gastrointestinal Effects
Cardiothoracic Surgery Without Cardiopulmonary Bypass in the Neonate
Pulmonary Artery Banding
Systemic to Pulmonary Artery Shunt Placement
Coarctation of the Aorta Repair
Vascular Ring Division
Mechanical Circulatory Support in the Neonate with Congenital Heart Disease
Perioperative Issues and Some Special Considerations in the Neonate Undergoing Cardiac Surgery
Pulmonary Hypertension
Systemic Hypotension
Congestive Heart Failure
Cyanosis
Ventricular Pressure Overload
Ventricular Volume Overload
Myocardial Ischemia
Altered Respiratory Mechanics
Systemic Air Embolization
Conduction Disturbances and Arrhythmias
Perioperative Stress Response
Post-cardiac Transplant Recipients
Summary
References
12: ECMO for the Neonate
Introduction
Patient Selection
ECMO Circuit Components
Gas Exchange on ECMO
Modes of ECMO
ECMO Management
Cannulation and ECMO Initiation
Anticoagulation and Homeostatic System in Neonates
Mechanical Ventilator Management
Sedation and Analgesia
Fluid Management
Decannulation
Complications
Survival and Outcome
Anesthesia Considerations for a Surgical Procedure on ECMO
Intraoperative Conduct of Anesthesia
Transfer of Neonates to the Operating Theater
Monitoring During ECMO and Surgical Procedure
CDH and ECMO
Trends in Neonatal ECMO: The Future
Conclusion
References
13: Anesthesia Outside the Operating Room
Neonates Are Not Small Children
Benefits of Performing Surgery in the NICU
Patient Indications for Surgery in the NICU
Logistics of Performing Surgery in the NICU
Vascular Access
Anesthesia Requirements
Sedation and Analgesia for Common Procedures in the NICU
High-Frequency Ventilation
Transport
Specific Conditions Requiring Surgery in the NICU (For Further Details, See Chap. 9 “Thoracoabdominal Surgery”)
Closure of PDA
NEC
SIP
Gastroschisis
Retinopathy of Prematurity (See Chap. 2)
CDH
Other Reported NICU Surgical Procedures
Sedation for Imaging Procedures (MRI/CT)
Cardiac MRI
Cardiac Catheterization Laboratory
Preanesthetic Assessment of the Neonate in the Cath Lab
Anesthetic Technique
Complications
Interventional Radiology for Neuroimaging
Conclusion
References
14: Fetal Surgery and the EXIT Procedure
Introduction
Anesthetic Considerations for Fetal Surgery
Preoperative Evaluation of the Fetal Surgery Patient
Maternal Physiology
Maternal Circulatory System
Maternal Airway and Pulmonary Systems
Other Maternal Physiologic Changes
Uterine and Placental Physiology
Fetal Physiology
Fetal Pain Perception
Anesthetic Neurotoxicity
Anesthetic Management for Minimally Invasive Fetal Procedures
Anesthetic Management for Open Fetal Surgery
Postoperative Considerations
Specific Fetal Conditions Amenable to Fetal Treatment
Fetal Anemia
Twin Reversed Arterial Perfusion (TRAP) Sequence
Twin-to-Twin Transfusion Syndrome (TTTS)
Congenital Heart Disease
Obstructive Uropathy
Congenital Diaphragmatic Hernia (CDH)
Congenital Pulmonary Lesions
SCT
MMC
The Ex Utero Intrapartum Treatment (EXIT) Procedure
Conclusions
References
15: Neonatal Pain: Significance, Assessment, and Management
Neonatal Pain Mechanisms
Significance of Neonatal Pain
Effects of Analgesics
Assessment of Neonatal Pain
Pain Measurement Tools
Selecting an Appropriate Pain Assessment Tool
Management of Pain
Information and Protocols: Pain Management Plans
Multimodal or Balanced Analgesia
Pharmacological Methods
Acetaminophen (Paracetamol)
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Opioids
Morphine
Fentanyl
Remifentanil
Hydromorphone
Codeine
Tramadol
Non-opioid Analgesics
Clonidine and Dexmedetomidine
Ketamine
Local Anesthetics
Lidocaine, Bupivacaine, Levobupivacaine, Ropivacaine, Chloroprocaine
EMLA, Amethocaine Gel, and Other Topical LA Preparations
Sucrose
Postoperative Pain Management
Group 1: Inguinal Hernia Repair, Circumcision, Pyloromyotomy, etc.
Group 2: Major Gastrointestinal or Genitourinary Surgery
Group 3: Cardiothoracic Surgery or Complex Gastrointestinal/Genitourinary Surgery
Analgesia for Neonates in ICU
Procedural Pain
References
16: Regional Anesthesia for Neonates
Introduction
Risks and Benefits
Anatomical Considerations [80–87] (Table 16.2)
Pharmacological Differences
Neuraxial Blockade
Spinal
Caudal Block
Caudal Catheter Techniques
Lumbar and Thoracic Epidural
Sacral Epidural Block
Continuous Epidural Infusions
Epidural Adjuvants
Ultrasound Imaging of the Spinal Cord
Peripheral Nerve Blocks
Management of Local Anesthetic Toxicity
Conclusion
References
17: Anesthetic Complications in the Neonate: Incidence, Prevention, and Management
Introduction
Peri-anesthetic Mortality and Adverse Events
Peri-anesthetic Cardiac Arrest
Respiratory and Airway Complications
Additional Considerations
Location of Operative Procedures
Transfusion of Blood Products
Vascular Access
Oxygen Toxicity
Prevention of Adverse Events
Human Factors
Medication Errors
Equipment-Related Incidents
Addressing Risks and Adverse Events
Conclusion
References
18: Do Anesthetic Drugs Harm Neonates? A Global Perspective
Introduction
Animal and Preclinical Data
At What Age Are Animals Particularly Vulnerable to or Safe from Neurocognitive Effects of Anesthetics?
Does the Duration of Exposure Impact Long-Term Effects?
Do All Anesthetic Agents Cause Neurocognitive Dysfunction?
Intravenous Anesthetics
Intravenous vs. Inhaled Anesthetic Neurocognitive Effects
Inhalation Agents
Single Inhalational Agents
Pairwise Comparisons
Comparison of Three Inhalational Anesthetics
Is There a Difference Between Single and Multiple Exposures or the Duration of Exposure on Apoptosis?
Are There Any Preventative Measures or Treatments That May Attenuate This Insult?
Translation and the Effects of Surgery
Human Studies
Retrospective Cohort Studies
Twin and Sibling Studies
Large Databases
Prospective Human Trials
Relevant Human Outcome Measures, Population Migration, and Sample Sizes
Age at Exposure, Duration of Surgery/Number of Exposures, and Impact of Surgery
Sex, Parenting, and Low Birth Weight
Future Studies
Other Aspects
Important Issues to Consider
Conclusion
References
19: Neonatal Resuscitation for Anesthesiologists
Introduction
Equipment
Physiology of Transition at Birth (Fig. 19.3)
Fetal Circulation (Fig. 19.3a)
Transition at Birth and Deferred Cord Clamping (DCC)
Asphyxia
Physiology of Resuscitation
Preparation for Delivery
Positioning
Temperature Management
Stimulation
Monitoring
Approach to an Infant Born Through Meconium Stained Amniotic Fluid (MSAF—Fig. 19.9)
Positive Pressure Ventilation (PPV)
Oxygen
Intubation
Indications for Tracheal Intubation in the DR
Size of the ETT
Confirmation of Tube Position
Depth of Insertion of ETT in Neonates (Fig. 19.16)
Deterioration after Intubation
Chest Compressions
Epinephrine in the DR
Volume Expansion
Discontinuation of Resuscitation
Conclusion
References
20: Ethical and Medicolegal Considerations
Reasoning About Ethical Concerns
The Four Principles Approach to Ethical Reasoning
Limitations to the Four Principles Framework
Perioperative Applications of the Four Principles Framework
Autonomy
Non-maleficence
Beneficence
Justice
Perioperative Do-Not-Resuscitate Orders
Regulatory Concerns in Perinatal Care
The Baby Doe Regulation Controversy
Born Alive Infant Protection Act
Conclusions
References
Index
