Annual Scientific Meeting - 2001

Total Intravenous Anaesthesia for Neonates.

Dr David J Sapsford

 Anaesthesia for the neonate, especially the sick neonate who may be opioid resistant, can be challenging.  The neonate has limited cardiopulmonary reserve, has the unique haemodynamic sensitivity of reverting to the foetal circulation and thus may be quite susceptible to the adverse effects of all anaesthetic agents, particularly hypotension.

There is also the added complication, that neonatal ventilators especially the oscillating sub-type will not allow the addition of an anaesthetic vapouriser to the breathing system, making inhalational anaesthesia almost impossible.

We now have many intravenous agents that can be effectively used for neonatal TIVA.

Ketamine has been used with good results and concerns of increased pulmonary vascular resistance or intracranial morbidity have not been realised.

The introduction of propofol has not been without controversy in the paediatric arena.  However there are many examples of its beneficial use within a TIVA regime for neonates.

The displacement of morphine / fentanyl by alfentanil and remifentanil has produced exciting opportunities for TIVA in neonatal practice.

It is the uncertainty of the neonates physiological response and the unpredictability of the pharmacokinetic / pharmacodynamic profile which prevents widespread adoption and realisation of the benefits of TIVA in the neonatal population.

I wish to discuss the benefits and how I administer TIVA for neonatal surgical procedures.