Neumann Roland P, von Ungern-Sternberg Britta S
Department of Neonatal Intensive Care, Basel University Children's Hospital (UKBB), Basel, Switzerland.
Paediatr Anaesth. 2014 Jan;24(1):10-21. doi: 10.1111/pan.12280. Epub 2013 Oct 24.
This review article focuses on neonatal respiratory physiology, mechanical ventilation of the neonate and changes induced by anesthesia and surgery. Optimal ventilation techniques for preterm and term neonates are discussed. In summary, neonates are at high risk for respiratory complications during anesthesia, which can be explained by their characteristic respiratory physiology. Especially the delicate balance between closing volume and functional residual capacity can be easily disturbed by anesthetic and surgical interventions resulting in respiratory deterioration. Ventilatory strategies should ideally include application of an 'open lung strategy' as well avoidance of inappropriately high VT and excessive oxygen administration. In critically ill and unstable neonates, for example, extremely low-birthweight infants surgery in the neonatal intensive care unit might be an appropriate alternative to the operating theater. Best respiratory management of neonates during anesthesia is a team effort that should involve a joint multidisciplinary approach of anesthetists, pediatric surgeons, cardiologists, and neonatologists to reduce complications and optimize outcomes in this vulnerable population.
这篇综述文章聚焦于新生儿呼吸生理学、新生儿机械通气以及麻醉和手术引起的变化。讨论了早产儿和足月儿的最佳通气技术。总之，新生儿在麻醉期间发生呼吸并发症的风险很高，这可以用他们独特的呼吸生理学来解释。尤其是闭合气量和功能残气量之间的微妙平衡很容易被麻醉和手术干预打破，从而导致呼吸功能恶化。理想的通气策略应包括应用“肺开放策略”以及避免不适当的高潮气量和过度给氧。例如，在危重症和不稳定的新生儿中，极低出生体重儿在新生儿重症监护病房进行手术可能是手术室的一个合适替代方案。麻醉期间新生儿的最佳呼吸管理需要团队协作，应由麻醉师、小儿外科医生、心脏病专家和新生儿专家采取多学科联合方法，以减少并发症并优化这一脆弱人群的治疗结果。
