The child who is in age up to 28 days is considered newborn. Distinguish the full-term newborns who were born 37 and more weeks after conception and premature which were born earlier in time. Some authors also mark out category of postmature children who have gestational age more than 42 weeks.
Operative measures by the newborn carry out, as a rule, for the purpose of correction of various malformations which cannot be postponed for later term and also when developing various acute surgical pathology. In view of high anesthesiology risk at this category of patients it is necessary to weigh carefully indications to an operative measure.
Preoperative training of the newborn for operation shall include:
Definition of degree of a donoshennost and pre-natal anamnesis of the child
Weighing and the conclusion on extent of physical development
Assessment of the general condition of the child and his physical inspection (survey, palpation, percussion, auscultation)
Detection of obvious and possible malformations
Laboratory screening: general blood test and urine, if necessary: biochemical analysis of blood, gemostaziogramm, acid-base state
At inspection pay attention to the child's weight. Despite the development of a neonatology taking place now the low weight of the newborn is considered one of the most important factors in postoperative lethality. The weight of 1000 grams and less is considered extremely low.
Premedication in a neonatology usually is not required. Some doctors traditionally use atropine for the purpose of suppression of vagal reactions, but its use is not obligatory. It is very important to explain to mother all questions concerning the mode of preoperative starvation as on the one hand, it is necessary to exclude a hypovolemia and a hypoglycemia to which newborn children are especially predisposed, and with another — to have on the operating table of the child with an empty stomach to minimize danger of regurgitation and aspiration.
Intraoperative monitoring shall include an electrocardiography, a pulsoksimetriya, noninvasive measurement of the ABP, temperature monitoring, gas monitoring. According to indications monitoring of the invasive ABP, TsVD, warm emission, BIS and other types of monitoring in addition can be used.
The special value in intraoperative providing newborns occupies maintenance of a normotermiya. Newborns are very sensitive to cooling therefore various ways of warming are used: heating of the operating table, heating of air in the operating room, active external warming by means of suspended systems, warming and moistening of the respiratory mix given from the narcotic device, having burned slightly solutions. Body temperature is controlled surely by means of the central and peripheral temperature sensors.
As venous access for newborns the peripheral vein is usually used, but in certain cases use also catheterization of the central veins. Use of EMLA cream for anesthesia of an installation site of a peripheral catheter is not recommended as prilokain it is quickly soaked up and can cause intoxication of the child and development of a methemoglobinemia. It is reasonable to use for this purpose pantocain in the form of gel.
For induction at newborns it is usually used sevoran, given in high concentration that promotes fast backfilling of the child. From intravenous anesthetics use thiopental. Concerning a propofol newborns have no data on its safety. Ketaminum is used in separate situations, as a rule, as a part of the combined anesthesia. When carrying out IVL it is necessary to remember danger of high concentrations of oxygen to newborns, especially it concerns premature.
For maintenance of passability of the upper airways the orotracheal intubation of a trachea is most often used. The laryngeal mask is used less often. From relaxants it is most often applied atrakuriya or tsisatrakuriya in view of the ability to hofmannovsky elimination and independence of function of kidneys.
For an analgesia at newborns regional techniques can be used as system technicians (opiates, ketamine), and. From regional the technician gained the greatest distribution caudal blockade as thanks to good distribution at newborn anesthetics in an epidural space, it is possible to receive without problems from caudal access blockade even of verkhnegrudny segments. Widely use spinal anesthesia.
In the postoperative period use paracetamol, narcotic analgetics, the prolonged caudal blockade, an epidural analgesia. Non-steroidal anti-inflammatory drugs are not used because of their influence on function of kidneys.