Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2014
ReviewAnesthesia and long-term outcomes after neonatal intensive care.
As survival is now increasing, care of the extremely preterm infant is now directed at strategies to minimize long-term morbidity. In this study, I review the current state-of-the-art outcomes for babies born at extremely low gestations and identify strategies that may be aimed at optimizing outcomes. With respect to anesthetic practice, I then go on to discuss important issues of pain management in these babies and how this may affect long-term outcomes.
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Paediatric anaesthesia · Jan 2014
ReviewBeyond survival; influences of blood pressure, cerebral perfusion and anesthesia on neurodevelopment.
Neonates have a higher perioperative mortality risk largely due to the degree of prior illness of the infants, the complexity of their surgeries, and infant physiology. It is important to consider contributing anesthetic factors during the perioperative period that may affect cerebral perfusion and neurocognitive outcome, such as alterations in hemodynamics and ventilation. Limitations of blood pressure as a marker for cerebral perfusion are discussed, as well as the effect of hypocapnia on the brain.
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Neonates are the most vulnerable age group in terms of anesthetic risk and perioperative mortality, especially in the developing world. Prematurity, malnutrition, delays in presentation, and sepsis contribute to this risk. Lack of healthcare workers, poorly maintained equipment, limited drug supplies, absence of postoperative intensive care, unreliable water supplies, or electricity are further contributory factors. Trained anesthesiologists with the skills required for pediatric and neonatal anesthesia as well as basic monitoring equipment such as pulse oximetry will go a long way to improve the unacceptably high anesthetic mortality.
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Paediatric anaesthesia · Jan 2014
Editorial Historical ArticleEarly events and lifelong change: looking beyond survival in the very young.