Neonatal Surgery

Neonatal Surgery
By:Juan E Gonzalez, CRNA, MS, ARNP
Based on prior lecture by
John P. McDonough, CRNA, Ed.D., ARNP
Professor & Director
Anesthesiology Nursing

Anatomical Differences
Pedi vs. Adult Airway
More Vertical
Less vertical
R mainstem bronchus
V-shaped
U-shaped
Shape of Epiglottis
Glottis
Cricoid
Narrowest Point
C3-C6
C2-C4
Laryngeal location

Head Position
Visual Alignment of Oral/Pharyngeal/Laryngeal axes
Attempt to achieve “sniffing” position will OBSTRUCT pt
Intubation
To intubate or not to intubate…
Is that a question??
Choice of Intubating Technique
Choice of Intubating Technique
(patient factors)
Blood Pressure Control
Emergence
Surgeries in the First Week of Life
* Congenital Diaphragmatic Hernia (CDH)
* Omphalocele & Gastroschisis
* Tracheoesophageal Fistula (TEF) (hrs-days to diagnose)
* Intestinal Obstruction (hr-days to diagnose)
* Meningomyelocele
Confounding Factors
* Prematurity
* Associated Congenital Anomalies
Maternal Cocaine Use in Pregnancy
Congenital Diaphragmatic Hernia
Embriologic features of CDH
CDH scenarios
CDH Clinical Presentations
Surgery & CDH
Anesthesia & CDH
Omphalocele
Gastroschisis
Delivery Room Management of Gastroschisis
Gastroschisis Periop Concerns
Postop Care of Gastroschisis & Omphalocele
Tracheoesophageal Fistula (TEF)
TEF Clinical Presentation
TEF Anesthetic Considerations
Tracheoesophogeal Fistula
“VATER” syndrome
Vertebral defects
Anal atresia
TEF
Esophageal atresia
Renal dysplasia
Intestinal Obstruction (Upper GI obstruction)
Intestinal Obstruction (Lower GI obstruction)
Lower GI obstruction
Meningomyelocele
Meningomyelocele
Hydrocephalus
Hydrocephalus Anesthetic Approach
Surgical Procedures in the First Month of Life
Inguinal Hernia Repair (IHR)
Inguinal Hernia Repair Anesthetic Techniques
Inguinal Hernia Repair Post Op Apnea in Premies
Ligation of PDA
Placement of Central Venous Catheter
References

Neonatal Surgery.ppt