Best practice & research. Clinical anaesthesiology
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It is not known if the fetus can actually feel pain, but noxious stimulation during fetal life does cause detectable stress responses. These responses cause both short and long-term changes in the central nervous system, which can affect subsequent pain behaviour. ⋯ However, the optimal amount of suppression required and the best method of achieving this (opioid or regional anaesthesia techniques) remain unknown. Prevention and treatment of pain is a basic human right, regardless of age, and if the technique of fetal surgery is to progress then a greater understanding of nociception and the stress response is required.
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Best Pract Res Clin Anaesthesiol · Jun 2004
ReviewMajor abdominal surgery of the neonate: anaesthetic considerations.
The anaesthetic handling of neonates scheduled for major abdominal surgical procedures is one of the most demanding tasks that can confront an anaesthesiologist. This chapter will review the specific physiological characteristics of the newborn with relevance to anaesthesia and will also provide robust guidelines for the anaesthetic handling of the most frequent diagnoses that need major abdominal surgery during the neonatal period.
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Best Pract Res Clin Anaesthesiol · Jun 2004
ReviewAnaesthetic considerations for the management of very low and extremely low birth weight infants.
The opportunities for very low birth weight infants (birth weight < 1500 g) and extremely low birth weight infants (birth weight < 1000 g) to undergo surgery are increasing. These infants are prone to prematurity-related morbidities including respiratory distress syndrome, intraventricular haemorrhage, periventricular leukomalacia, retinopathy of prematurity, patent ductus arteriosus and necrotising enterocolitis. ⋯ Key anaesthetic considerations are (i) inspired oxygen concentration that should be adjusted to avoid hyperoxia, (ii) haemodynamic parameters that should be kept stable and (iii) prevention of hypothermia by using adequate measures to keep the infants warm. These precautions must be continuously taken during the operation and the transport to and from the operating theatre.
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Best Pract Res Clin Anaesthesiol · Jun 2004
ReviewEx utero intrapartum surgery (EXIT): indications and anaesthetic management.
The ex utero intrapartum treatment (EXIT) procedure is a technique for safely managing airway obstruction at birth, in which placental support is maintained until the airway is evaluated and secured. In addition to the usual considerations of anaesthesia in obstetrics there are special considerations relating to the EXIT procedure: maintaining fetoplacental circulation by profound uterine relaxation and achieving fetal anaesthesia for airway manipulations. This chapter focuses on the key issues involved in managing this procedure: the indications, preoperative concerns, organization of a multidisciplinary team, problems of maternal and fetal anaesthesia, maintenance of the uterine relaxation and control of fetal airway.
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Best Pract Res Clin Anaesthesiol · Jun 2004
ReviewRegional anaesthetic techniques for neonatal surgery: indications and selection of techniques.
The goal of neonatal care is to optimise the outcome of term and preterm infants with minimal suffering. Neonates are rare patients for the anaesthetist, therefore personal and even global experiences are limited. ⋯ With the exception of heel lancing, regional techniques are useful in all cases. However, a careful risk-benefit analysis is mandatory, especially when considering more invasive techniques such as epidural catheters.