**Neonatal Care for Anesthesiologists**

**Neonatal Care for Anesthesiologists**

#### Esra Caliskan Additional information is available at the end of the chapter

Esra Caliskan

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.71952

**Abstract**

In recent years, developments in obstetrics and neonatology have significantly improved the survival and quality life time of neonates. Therefore, anesthesiologists are more confronted with these patients due to surgical and non-surgical procedures. For a safe anesthetic approach and safe care, anesthesiologist must have necessary knowledge and equipment on the physiology of the newborn and should be better understand how immature organs respond to surgery and anesthetic. The purpose of this section is to present spot information that will allow clinicians and anesthesiologists to better understand the problems of neonatal patients and to perform safe care for these patients in the light of the physiologic characteristics of neonates. General principles of anesthetic management of neonatal patients are also reviewed and discussed.

DOI: 10.5772/intechopen.71952

**Keywords:** neonatal physiology, anesthetic management, perioperative evaluation, postoperative care, neonatal surgery

#### **1. Introduction**

Differently from the adult patients, pediatric, especially neonatal age group is a patient population that is difficult to assess. It should not be forgotten that children are not miniaturized adults. Therefore, the preoperative evaluation of the neonate is admittedly the most important part of anesthetic evaluation. The developments in the field of neonatal medicine over the past two decades have increased our probability of encountering a healthy and unhealthy neonatal population [1]. Surgical procedures especially emergency surgical conditions can be represent a significant anesthetic challenge and life threatening in neonatal period [2, 3].

Therefore, the anesthetist needs to take into account the immature function of many vital organ systems, the normal course of development, the effects of the underlying pathologic disease processes, which can frequently lead to serious physiological instability [4, 5].

Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons

In this chapter will be discussed issues that related to the anesthetic approach and postoperative care to neonatal patients.

The onset of spontaneous breathing is the main factor that reduces high PVR which is characteristic of fetal circulation. This decrease in pulmonary pressure is followed by an increase in systemic vascular resistance and left atrial pressure. Some clinical situations such as hypoxia and acidosis may lead to reduction of pulmonary blood flow which causes a return the fetal

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Cardiac function is heart rate dependent in healthy neonates because the immature myocar-

The parasympathetic system is predominant in neonates [10], so that vagal stimulus by laryngoscopy and hypoxia may cause bradycardia. Therefore, it should be avoided bradycardia

Liver and kidney function are also closely related to the anesthetic management of neonates. In the neonatal period, both organs have not yet completed maturation. The liver serves a critical role in carbohydrate, protein, lipid metabolism, coagulation. And is the primary site for biotransformation of drugs [13]. Hepatic oxidation, reduction and hydrolysis maturation process is rapid and these functions reaches adult rates around 6 month of ages [14]. Because of this, newborns may metabolize drugs (include anesthetic drugs) and toxins less efficiently than adults in the early months of their lives, as the pathway of degradation is immature [1]. Also, one of the changes in early infancy is the lower concentration of total serum protein, albumin and α1-acid glycoprotein. These proteins reach the adult level at

One of the main routes of clearance of drugs and metabolites are the kidneys too. Glomerular filtration rate (GFR), active secretion and passive reabsorption are functions that determine

The kidneys also play an important role in the maintaining of acid base homeostasis and fluid electrolyte balance. GFR and reabsorption are increase age dependent manner. A neonate's

In the perioperative period, fluid electrolyte balance is affected and the metabolism of commonly used anesthetic drug altered [10]. Drug metabolism and protein binding are also

Maturational physiologic changes are most prominent in neonatal period and infancy. The distribution of total body fluid component in neonates is different from adults. Body fluid constitute a greater proportion of body weight in the neonate (approximately 70–75%) and higher than adults. In neonate, the intracellular and extracellular fluid compartments are approximately 45 and 33% of body weight, respectively [17]. These body component changes

The newborn baby has a greater surface area relative to weight and a thin layer subcutaneous fat tissue [3]. These properties cause more heat loss to the environment in neonates than older

kidney takes approximately 6–12 months to achieve adult performance.

reduced due to immature organ (hepatic and renal) function [16].

circulation features that is called persistent fetal circulation (PFC) [11].

dium has limited compliance [2, 12].

about 1 year old [14].

renal excretion of drugs [15].

affect volumes of distribution of drugs.

**2.2. Thermoregulation**

and treated aggressively when it is observed.
