4^th International Anesthesia and Pain Medicine Conference

The Micropremies are preterm neonates is borne before 30 gestational weeks and have extremely low birth weight infants (<1000 g). Morbidity and mortality in this population has decreased over the past decades and general anesthesia is increasingly needed for surgical and diagnostic procedures. Knowing their unique physiological features is necessary. Common complications of prematurity include: postoperative apnea, broncho-pulmonary dysplasia, patent ductus arteriosus (PDA), right to left shunt, intraventricular hemorrhage, long term cognitive impairment, retinopathy of prematurity, altered temperature regulation with impaired renal and metabolic functions. The debate continues upon who should provide the care and where to do these cases. Preoperative preparation focuses on optimization of cardiac and respiratory status and on treatment of anemia, electrolyte abnormalities, metabolic acidosis and coagulopathy. There are 2 common scenarios, the first is a relatively stable micropremie with a secured IV access coming for ligation of PDA where a high dose fentanyl and a relaxant will do the job. The second scenario is an unstable micropremie with difficult venous access, hypothermic,

hemodynamically unstable with coagulopathy and thrombocytopenia coming for laparotomy for NEC. Management differs if they are on conventional ventilation or on HFOV. Permissive hypercarbia is common in NICU setting. The decision to conventionally or manually ventilate them is critial as they usually go hypocapnic and hypocalcemic that may be detrimental to their myocardium.

Common problems are hypotension and hypovolenia, hypothetmia, hypocapnia and hypocalcemia.