Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, Harvard Medical School, Massachusetts, USA.
Early Hum Dev. 2010 Nov;86(11):703-14. doi: 10.1016/j.earlhumdev.2010.08.008. Epub 2010 Oct 16.
The general principles that guide a pediatric anesthesiologist in the care of a newborn needing urgent and emergent neonatal surgery are reviewed. These include careful evaluation and assessment of the newborn including a detailed prenatal history. A brief review of neonatal physiology including the development of the autonomic nervous system and the development of nociceptive pathways is discussed and how important it is to suppress the stress response to surgical intervention in order to improve surgical outcomes. Most of the current general anesthetics have been associated with anesthetic neurotoxicity in juvenile mammals and several epidemiologic studies in human infants and toddlers have linked surgery occurring in the first 3 years of life with neurocognitive delays in school age children. These concerns are discussed in this paper. Practical considerations about neonatal intubation, line placement and intraoperative fluid management are also reviewed. And the anesthetic management of specific neonatal conditions such as congenital diaphragmatic hernias, transesophageal fistulas, gastroschisis and omphaloceles, necrotizing enterocolitis and meningomyeloceles is examined.
本文回顾了指导儿科麻醉医师为需要紧急和急诊新生儿手术的新生儿提供护理的一般原则。这些原则包括仔细评估和评估新生儿，包括详细的产前史。简要回顾了新生儿生理学，包括自主神经系统的发育和伤害感受途径的发育，以及抑制手术干预应激反应以改善手术结果的重要性。目前大多数全身麻醉药与幼年哺乳动物的麻醉神经毒性有关，几项针对人类婴儿和幼儿的流行病学研究表明，生命最初 3 年内发生的手术与学龄儿童的神经认知发育迟缓有关。本文讨论了这些问题。本文还回顾了新生儿插管、置管和术中液体管理的实际注意事项。并检查了特定新生儿情况的麻醉管理，例如先天性膈疝、食管-气管瘘、腹裂和脐膨出、坏死性小肠结肠炎和脊髓脊膜膨出。
