| Anesthesia Induction |
- Anesthesia to state when EHR record transitions to Anesthesia
- Fentanyl and vecuronium
- Add ketamine bolus or low-dose propofol infusion as indicated
- Adjust ventilator rate to account for neuromuscular blocking agent
- Draw arterial blood gas
- Minimize FiO2 to allow the pulse oximeter to indicate changes in oxygenation
- Increase FiO2 by 10% for surgery
- FiO2 should not be increased further without discussion with neonatology as it is difficult to wean post-operatively
-
Antibiotics Prior to Incision
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| Maintenance/Intraoperative Considerations |
- Titrate anesthetics and vasoactive infusions as indicated
- Communicate any hemodynamic changes to the surgeon
- Hemodynamic compromise may occur during reduction of abdominal contents, as well as with liver manipulation and surgeons may need
to pause
- As abdominal wall is closed, communicate any changes in ventilation to
the surgeon
- Respiratory compromise may occur with abdominal wall closure
- Blood gas every 30-60 mins
- In the event of acute change in CO2, drop in heart rate or desaturations, ETT position and kinking should be considered
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| Thermoregulation |
- Goal ≥ 36
- Forced air (i.e., Bair Hugger) warming is preferred over chemical mattress to allow warming throughout the duration of the procedure
- Diaper should remain under baby to keep urine off body
- Hat should be on to maintain normothermia
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| Anesthesia Considerations for Repair on ECMO |
- Due to absorption by the circuit, infant will likely require higher doses of opioids; consider addition of ketamine
- Medications should be administered to the infant and not the circuit
- Prepare for significant bleeding
- pRBCs, FFP, and platelets at bedside
- Discuss transfusion strategy with Neonatology Attending
- Excess FFP may lead to clots in the circuit and result in need for
circuit exchange
- Circuit may “cut out” in setting of hypovolemia and/or liver manipulation
- Amicar infusion per:
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