Journal Reading

Neonatal anesthesia:
how we manage our most
vulnerable patient

Si Ra Bang
Department of Anesthesiology and
Pain Medicine, Seoul Park Hospital
and Inje University, Seoul, South Korea
Presented by : Irfan TBW
 The prevalence (the number of babies born with heart
defect compared to the total number of births) of some
CHDs, especially mild types, is increasing, while the
prevalence of other types has remained stable

About 25% of babies with a CHD have a critical CHD.

Infants with critical CHDs generally need surgery or
other procedures in their first year of life

The most common type of heart defect is

ventricular septal defect (VSD)

Infant deaths due to CHDs often occur when the baby is less
than 28 days old (sometimes called the neonatal period). In a
study of neonatal deaths, 4.2% of all neonatal deaths were
due to a CHD.

(CDC, Atlanta, USA, 2018)

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(Haberkern, Seattle Children’s Hospital, 2015)

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 Presence of
Prematurity Congenital lesion or
NEONATES ARE NOT
syndromes SMALL ADULTS

Disease process Narrow margin for

particular to error regarding drug  Airway  Ventilation
neonates including administration and  Cardiovascular
NEC and PDA dilution  Neurologic

difficulty of correct
placement of
endotracheal tube

The following risk associated with

neonatal anesthesia
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Heart Cardiogram PowerPoint
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 Avoid atelectrauma
Major Goals
Prevent alveolar over distention
Minimize oxygen toxicity

PEEP
Strategy
Smaller tidal volume

Recruitment Maneuver

Lung protective ventilation surgery

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 Oxidative stress, free radical
production

Oxygen:
Friend or Organ damage, including Chronic
Lung Disease
Foe?

Spo2 target ?

↓ Short & long term morbidity /

mortality with neonatal resuscitation
using RA rather than 100% O2
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 GFR
98% = 2nd
year
90% = 1st
year
35% = birth

10% = 25th
weeks TBW & extracellular
gestational
age fluid ↑

Body composition
Volume
Plasma protein binding Distribution

Regional blood flow

Blood brain barrier

permeability

Pharmacology
 Neuronal
Apoptosis
NMDA receptor
antagonist

Suppresion of
neurotrophic
synaptic signal

GABA receptor agonist

Volatile Agents

Anesthetic Induced Neurotoxicity

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 Metabolic
Acidosis
Painful
stimuli Hypo/hyper
glicemia Morbidity &
Electrolyte Mortality ↑
imbalance
Neurotoxic

Pain and Neurodevelopment

Conclusion

Neonates  Most Vulnerable Patient

Unique Phisiology

Careful treatment

Minimize Risk Outcomes

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Aims of Anesthesia for the Neonate

Essentially the same as those

for adult or child

Minimization of physiological,
humoral and behavioral signs of
distress

Ablation of consciousness &

recall

Maximization of perioperative
outcomes
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