Anesthesia for the premature infant

Abstract

The number of infants born prematurely has been increasing over the past few years; their survival rate has also been increasing because of the multiple advances in health care. The premature infants usually have a number of medical problems, asphyxia, ROP, NEC, HMD, BPD, deficient drug metabolism, IVH, hematologic derangements, temperature dysregulation, and they present often to surgery. The different medical problems associated with prematurity can be challenging for the anesthesiologist. Preterm infants require adequate anesthesia since they are capable of mounting a stress response otherwise. Preoperative evaluation of the medical problems of the infant is essential. Data on anesthetic requirements of premature is that few prematures require less anesthesia than mature newborns. Anesthesia can be induced with inhaled anesthetic agents but these cause hypotension. Thiopental or fentanyl given intravascular can be used instead. Fentanyl can be also used for maintenance. Ventilation should be manipulated during the operation to accommodate for the change in compliance and resistance due to retractors and packs. Fluid losses should be well estimated and replaced. Emergence is as dangerous as induction and involves the risk of apnea.