The newborn is not a small adult, there are many anatomical and physiological differences. If itꞌs possible, we postpone the operation until later age. However, exceptions exist, such as a congenital malformation, an acute case etc. and we are forced to perform operation as soon as possible. In these situations, the specialized departments take action. In our algorithm youꞌll encounter pylorostenosis which is the congenital malformation (2-5/1000 newborns) causing disorder of the passage.
The operation and the anaesthesia of newborns are indicated only in specialized hospitals with adequate technical equipment and skilled professionals. The algorithm of newborn’s anaesthesia for operation of pylorostenosis fully respects clinical situation and guidelines. Draining the stomach content immediately before the anaesthesia introduction is highly recommended. After that the risk of stomach regurgitation is minimal. The introduction to anaesthesia and the airway management are rightly chosen, I personally prefer a gas anaesthesia introduction. For the anaesthesia maintenance the inhalational anaesthetics are applied. A small dose of opioids could be used given by gestational age of newborn (Alfentanil 2-4 ug/kg, Sufentanil 0,05 ug/kg). Using muscle relaxants isn't needed, apart from indicated cases in which we should always remember to immature muscle tissue and a long-lasting effect of elimination. PCV is preferred type of new-borns ventilation as a prevention of barotrauma and volumotrauma. We are careful about reduction of dead space and sufficient alveolar ventilation. Congratulation on creating an algorithm that describes a clinical situation very well and it certainly will be a good educational contribution.
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