Neonatal anaesthesia:

Airway

·      Small and easily obstructed

·      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

Breathing

·      Rapid desaturation when apnoeic

·      Oxygenation highly PEEP-dependent

·      Risk of oxygen toxicity

·      Risk of post-op apnoea

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

·      Get cold very quickly when exposed

·      Hypothermia causes apnoea

Fluids

·      Get dehydrated quickly when exposed

·      Easy to flood (2 x normal saline ampoules = 10mL/kg)

Glucose

·      Get hypoglycaemic quickly when not fed

Haemoglobin

·      Visually small blood loss may be significant

 

Feedback welcome at ketaminenightmares@gmail.com