7. Prematurity

Question 1

Implications of prematurity which may affect children in GA

Answer 1

1. Respiratory & airway
2. CVS
3. Neurological
4. Other

Question 2

1. Respiratory

Answer 2

Chronic resp disease
airway irritable
poorer compliance
V/Q mm
increase WOB

Postop respiratory apnoea

15s> w/out brady
15s w Brady cardia 12-24hours post GA

Subglottic or tracheal stenosis / tracheomalacia

Question 3

2. CVS

Answer 3

PDA

Prone to bradys

Question 4

3. Neurological

Answer 4

IVH / Hydrocephalus

GDD / CP risk / HIE / Seizures

Question 5

4. Other

Answer 5

Nutrition

Anaemia / abnormal clotting

Poor IV access / multiple cannulations

Physiological abnormality significant consider d/w surgical team re delay of

Tertiary centre w/ PICU

Question 6

Anaesthetic technique

Preop

Answer 6

1. Preop assessment
   Anaesthetic Hx - perinatal complication
   exam consent
2. Avoid prolonged fasting - risk hypo and dehydration
   local fasting guidelines
   consider preop IV fluid infusion
3. 2 Pead’s anaesthetists

Question 7

2. Intraop

Answer 7

If severely O2 dependent
consider awake spinal +- sedation

tracheal intubation and ventilation - greater control airway / gas exchange

o2 air volatile maintenance

Insert NG deflate stomach

Care opioids - sensitivity & risk preop apnoea

Caudal block / LA infiltration

PR paracetamol 50 20mg/kg

Normothermia - underbody heating / warmed iv fluids

Periop iv fluid therapy
maintenance normoglycemia

Question 8

3. Postoperative

Answer 8

Particularly high risk HDU / PICU

High risk apnoea
rep apnoea brady 24h post
resp monitoring mandatory
- Spo2 / RR / HR / Apnoea

Analgesia
PO paracetamol
LA/ RA

Encourage return to feeding asap
post op iv fluid regimen local guidelines not feeding or vomiting