Neonatal Physiology

Neonatal Physiology - NeonatalPhysiologyand Anesthesia...

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    Neonatal Physiology and  Neonatal Physiology and  Anesthesia Anesthesia Elena Brasoveanu, MD Elena Brasoveanu, MD Boston University Boston University March 2, 2006 March 2, 2006
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Pediatric Anesthesia Origin in the 1930’s at Toronto Hospital for Sick  Children when Robson described techniques only for  children Recognized subspecialty starting with 1946 when Robert  Smith became director of anesthesia at Boston Children’s  Hospital Now, approximately 49 fellowship programs
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Aspects of the Neonatal  Physiology The neonatal oxygen consumption is  approximately 6 ml/kg/min versus     3 ml/kg/min  in the adult Even under normal circumstances the immature  cardiac and respiratory systems must function  near maximum to support this metabolic demand.
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Respiratory Physiology The respiratory system is not fully developed at  birth and continues through early childhood. Airways fully developed at 16 wks of gestation Alveolarize at 24-28 wks with complete  maturation at 8 - 10 y.o.
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Respiratory Physiology (cont’d)   Increasing respiratory rate rather than tidal volume is  more efficient to increase alveolar ventilation The diaphragm is the primary respiratory muscle – has  fewer high-oxidative muscle fibers and is less resistant to  fatigue than the adult diaphragm
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Respiratory Physiology (cont’d) Awake FRC is similar, when normalized to body  weight, to that of an adult  FRC declines during anesthesia and combined  with hypoventilation and increased consumption  causes a rapid desaturation
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Respiratory Physiology (cont’d ) Central apnea- self limited in newborns,  approximately 5 seconds Apnea of prematurity – 20 seconds or associated  with desaturation episodes and bradycardia Resolves at 50- 55 weeks gestational age.
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Neonatal Physiology - NeonatalPhysiologyand Anesthesia...

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