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Inguinal Hernia of Premature Infants

Inguinal Hernia of Premature Infants. 2005/02/03 R1 林群博. Brief History. 2 months old male infant G3P1AA2 GA: 28 weeks+6 Birth body weight: 1302gm. Brief History. Maternal APH, PPROM, placental abruptio C/S on 2004/11/11 Apgar score: 7 → 8. Brief History.

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Inguinal Hernia of Premature Infants

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  1. Inguinal Hernia of Premature Infants 2005/02/03 R1林群博

  2. Brief History • 2 months old male infant • G3P1AA2 • GA: 28 weeks+6 • Birth body weight: 1302gm

  3. Brief History • Maternal APH, PPROM, placental abruptio • C/S on 2004/11/11 • Apgar score: 7→8

  4. Brief History • Frequent apnea episodes on 11/13-14 and aminophylline was given • Abscess and osteomyelitis in 2005/12 • Pre-op: BW: 2644gm • Herniorraphy for umbilical and right inguinal hernia on 2005/1/21

  5. Aminophylin Atropine 0.1mg Sevoflurane

  6. Discussion • 1. When should repair of inguinal hernia be done? • 2. Anesthetic risks for surgery of premature infants • 3. What kind of anesthetic technique is better?

  7. Inguinal Hernia in Prematurity • Incidence: 14-30%(children: 2%) • Higher incidence of incarceration in infants • Hernia repair when ready for discharge has be accepted Pediatr Surg Int (1999) 15: 36-39

  8. Inguinal Hernia in Prematurity • VLBW infants had a longer operation time and a longer waiting period • Preoperative medical complication: RDS, sepsis, and cardiac failure→ considered to delay surgery • The shorting waiting group had shorter operation time • No correlation between operation time and body weight at surgery

  9. Inguinal Hernia in Prematurity • For long waits for surgery in VLBW infants: hernia sac may grow large and thick, and fibrous adhesions may develop • Difficult surgical repair and the risk of gonadal ischemia may be increased

  10. The Most Common Medical Problems in Prematurity • Respiratory distress syndrome (RDS) • Apnea of prematurity • Anemia of prematurity • Patent ductus arteriosus • Intraventricular hemorrhage

  11. The Formerly Premature Infant • Bronchopulmonary dysplasia (BPD): 1. the sequelae of RDS 2. the leading cause of chronic lung disease during infancy 3. periodic episodes of bronchospasm, especially during URI

  12. Anesthetic Management of Infants with BPD • Optimization of respiratory status • Deep extubation to avoid bronchospasm • Regional analgesia in abdominal procedures for pain control

  13. Laryngeal and Tracheal Injury • Prolonged intubation and mechanical ventilation • Subglottic stenosis • Smaller ET tube when intubation • Stridor following extubation

  14. Postoperative Apnea • May be accompanied by bradycardia • Probably related to the effects of general anesthetic agents on the immature respiratory control center • Low gestational age, low postconceptional age, preoperative apnea of prematurity

  15. General VS Spinal Anesthesia • GA<36wks and post-conceptual age (PCA)<46wks • Exclude preexisting cardiac, neuromuscular or metabolic diseases • Preoperative hemoglobin and a history of preexisting abnormal respiratory function British Journal of Anaesthesia 86 (3): 366-71 (2001)

  16. General Anesthesia (Group 1) • Induction: 2 MAC sevoflurane and atracurium 0.5 mg/kg • Maintenance: 0.5-1.0 MAC sevoflurane until completion of skin closure • Reversed with neostigmine 50 μg/kg and glycopyrrolate 10 μg/kg • Caudal epidural injection with 0.25% bupivacaine 2 mg/kg

  17. Spinal Anesthesia (Group 2) • 0.5% bupivacaine 1 mg/kg • Caudal epidural injection with 0.25% bupivacaine 2 mg/kg

  18. Results • Spinal anesthesia was attempted unsuccessfully in four patients in group 2 • 5 patients in group 1 demonstrated an excess number of episodes of postoperative cardiopulmonary complications • 3 patients had preexisting abnormal respiratory function and accounted for 80% of the episodes

  19. Prevention of Postoperative Apnea • Performing a regional anesthetic instead of a general anesthetic • Perioperative administration of caffeine • Selection of general anesthetic agents or opoids that are characterized by their limited duration of action

  20. Regional Anesthesia • Lower incidence (not complete absence) of postoperative apnea • The risk is similar to general anesthesia hen adding systemic sedatives • Potentially stressful for the infant and associated with a clinically significant failure rate

  21. Thanks for Your Attention!!

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