Neonatal anaesthesia:

Airway

Anatomy:

·      Small dimensions

·      Laryngomalacia in 30%

·      High larynx (C3-4)

·      Large occiput

·      Obligate nose breather

Management:

·      BMV: keep mouth open, don’t press on neck

·      LMA: only as a get-out-of-jail card

·      ETT: towel under the shoulders, check cuff pressure (risk of stenosis)

Breathing

·      Rapid desaturation when apnoeic

·      Oxygenation highly PEEP-dependent

·      Risk of oxygen toxicity

·      Risk of post-op apnoea: esp if prem, ↓temp, ↓BSL, ↓Hb

Circulation

·      Hypoxia causes bradycardia

·      Fairly fixed stroke volume

Drugs

·      High risk of drug dose error

·      High risk of significant air embolism

·      Variably slower rate of metabolism

External

·      TNZ 32-34°

·      Get cold very quickly when exposed

·      Hypothermia causes apnoea

Fluids

·      Get dehydrated quickly when exposed

·      Easy to flood (3 x normal saline ampoules = 10mL/kg)

Glucose

·      Hypoglycaemic if not fed frequently

Haemoglobin

·      HbF 170-180 g/L

·      Visually small blood loss may be significant

 

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