Neonate : Colligative - Practical Wisdom in Anesthesia, Surgery, and Medicine.

Nov 27, 2012

Blood gas values in samples taken from a UAC in a neonate may resemble venous blood. This occurs as a consequence intermittent right to left blood flow across a PDA or PFO, especially in procedures that may result in elevations of pulmonary vascular-resistance (PVR)

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Nov 22, 2012

If you have an arterial line ensure it aspirates and flushes before draping the patient.

You don't want to get caught with a sick neonate and unable to get blood intraoperatively.

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Jan 21, 2013

Place two pulse oximeters in different locations for prolonged procedures where the infant will be covered in case one malfunctions.
A pulse oximeter that “suddenly” stops working should warn of hypotension or poor peripheral perfusion. At these times a 2nd pulse oximetry probe is extremely useful to differentiate between failure of an individual probe vs. a true inability of the oximetry probe to obtain a signal from the patient.
Anaesthesia for Congenital Heart Disease, Andropolous p434

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Nov 27, 2012

Small gauge arterial cannulae (22g/24g) clot easily.
Flush the cannula as the 3-way tap is closed to stop any retrograde flow of blood that may clot within the cannula.

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Nov 27, 2012

Cancel

Positioning, Protection

Cancel

Temperature

Heat loss in neonate:
39% by radiation,
34% by convection,
24% by evaporation,
3% by conduction
refl.in/9a

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Nov 22, 2012

Take particular care to avoid hypothermia as neonates are at elevated risk of this. Radiant heat loss is significant and neonates have reduced capacity to generate heat.

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Nov 27, 2012

Warm the operating theater 2hrs before the case commences to warm up the walls and ceiling to reduce radiant heat loss from the patient

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Nov 27, 2012

Analgesia, Anesthesia, Antiemesis

Cancel

Cancel

Airway, Ventilation

If you're trying to reduce deadspace in the ventilation circuit for small neonates, consider removing the HME filter from the patient end of the circuit and replacing it with two filters at the machine end.
#example

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , Pieter Peach , more...

Private

only

Jan 01, 2013

Paediatric circle. The disposable paed circles can be used for all ages, even 500g nicu babes to 200kg adults. Just because many paed anaesthetists prefer the T piece, it is not compulsory to use it in neonates and you don't need to change this circle for adults.

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , Pieter Peach , more...

Private

only

Dec 19, 2011

Rule of thumb for depth of oral ETT in neonates:
1kg 7cm
2kg 8cm
3kg 9cm

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , Pieter Peach , more...

Private

only

Nov 21, 2012

Small endotracheal tubes kink easily as they warm up.
Reinforcing the section of tubing external to the patient with a section of another endotracheal tube 0.5-1 size larger can help avoid this.
#example

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , Pieter Peach , more...

Private

only

Jan 01, 2013

When using the T-piece in neonates and infants one technique is to occlude the flow of bag between the palm of the hand and the 4th and 5th fingers.

This does two things:

1. Improves ability to fine tune inspiratory pressures.

2. Provides a natural limit to the volume of deliverable gas in the bag that is more appropriate to their size

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , Pieter Peach , more...

Private

only

Dec 20, 2012

Endotracheal tube for a term newborn is generally a size 3.0 ETT, sitting 10cm at the lips. refl.in/is

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Sep 26, 2011

Estimate the distance to pass endotracheal tube ETT past vocal cords. Convert the internal diameter (in millimeters) to centimeters. For example, as 3.5mm ETT is passed 3.5cm through cords. Ensure clinical confirmation of bilateral ventilation is performed in all cases.

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Sep 26, 2011

Cancel

Cardiovascular, Fluids

Lower limit of cerebral autoregulation in neonates is approximately ~40mmHg under anaesthesia.
#ref #AD

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Dec 06, 2012

Cancel

Endocrine, Electrolytes

Monitor blood glucose closely. The neonatal brain is almost entirely dependent on glucose for energy requirements. Recurrent hypoglycemia may result in neurodevelopmental delay. refl.in/ld

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Nov 22, 2012

Neonates are dependent on serum calcium for myocardial contractility due to the immaturity of the sarcolemma. Consider hypocalcemia in the haemodynamically unstable patient and replace early. refl.in/26

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Nov 22, 2012

Haematological, Blood products

Cancel

Cancel

Special drug considerations

4ml/kg packed red blood cells raises haemoglobin by approximately 10g/L refl.in/5l

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Dec 19, 2011