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The former preterm infant and risk of post-operative apnoea: recommendations for management
S Walther-Larsen1, L S Rasmussen
1Department of Anaesthesia, Section 4013 Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. RH02090@RH.dk
Insights
Managing former preterm infants for anesthesia requires careful monitoring to prevent post-operative apnea. Guidelines recommend regional anesthesia and tailored monitoring based on post-conceptual age and health status.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Neonatal Care
Background:
- Preterm infants undergoing anesthesia pose significant challenges, with apnea and bradycardia being serious post-operative complications.
- Existing literature lacks extensive prospective, randomized, controlled studies on managing this population.
Purpose of the Study:
- To formulate evidence-based clinical guidelines for managing former preterm infants to prevent post-operative apnea.
- To provide clinicians with strategies for optimizing anesthetic care in this high-risk group.
Main Methods:
- A comprehensive literature search was conducted to identify relevant studies and data.
- Guidelines were formulated based on the synthesis of current evidence regarding anesthetic management and post-operative monitoring.
Main Results:
- Regional anesthesia, particularly neuraxial blocks, is strongly recommended.
- General anesthesia should avoid opioids and muscle relaxants.
- Post-conceptual age (PCA) dictates monitoring duration: <46 weeks requires ≥12h monitoring; 46-60 weeks requires tailored assessment and monitoring (≥12h if risk factors present).
- Intravenous caffeine (10 mg/kg) can reduce apnea risk.
- Referral to a tertiary center for anesthesia and surgery is advised for all these patients.
Conclusions:
- Evidence-based guidelines are crucial for managing former preterm infants to minimize post-operative apnea risks.
- Tailored anesthetic approaches and vigilant post-operative monitoring are essential for patient safety.
- Further research with larger randomized trials is needed to solidify best practices.
Abstract:
The preterm infant presenting for anaesthesia during the first 6 months of life is a major anaesthetic challenge. One of the most serious post-operative complications is apnoea with or without bradycardia. For this review, we conducted a search of the current literature in order to formulate a set of evidence-based clinical guidelines to help clinicians in the management of the former preterm infant to avoid post-operative apnoea. Only a small number of patients have been enrolled into prospective, randomized, controlled studies. Based on the current literature, regional anaesthesia is strongly recommended, preferably neuraxial block, but general anaesthesia is also used and in this setting, opioids and muscle relaxants should be avoided. Infants with a post-conceptual age of less than 46 weeks should be admitted for continuous monitoring for at least 12 h post-operatively. In infants with a post-conceptual age (PCA) between 46 and 60 weeks, a careful assessment of the child is mandatory and 12 h of respiratory monitoring is recommended if the patient's history reveals episodes of apnoea at home, chronic lung disease (CLD), neurological disease or anaemia. The otherwise healthy infant could be scheduled for theatre as the first patient on the list and subsequently monitored in the post-anaesthetic care unit for 6 h. The risk of apnoea in former preterm infants can be further reduced by the administration of intravenous caffeine (10 mg/kg). All of these patients should be referred to a tertiary centre for anaesthesia and surgery.
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