ANESTHETIC MANAGEMENT OF PRE•TERMS AND NEONATES

Abstract

In the past, anesthetic and analgesic agents have been with- held from neonates undergoing surgical procedures. Neonates, including preterm infants, demonstrate physiological responses to surgical procedures that are similar to those in adults and have shown to be more vulnerable to the negative effects of pain and stress. Physiology of neonates differs from adults in many ways. Control of breathing in the newborn is less mature and adaptation of lung mechanics takes several weeks after birth to complete. This leads to different responses to hypoxemia and hypercapnia in this age group, in addition to presence of irregular breathing (periodic breathing and central apnea, more in preterms), which makes them more vulnerable to respiratory complications. Lung volumes in neonates are less, in relation to their body weight, including the FRC, making them more i susceptible to atelactasis. Blood oxygen affinity in the newborn is

extremely high (PSO is low, 19mmHg) thus oxygen delivery at the tissue level is lower despite high red blood cell mass and hemoglobin level.