Anesthesia in the NICU

Congenital Diaphragmatic Hernia:

If the surgeon needs to repair the defect while the baby is on ECMO in the NICU, there  needs to be either an anesthesiologist or one of our the Neonatology attendings, fellows or NNP’s present for the case. Anesthesiology feels that the neonatology team is very competent to provide this support but will try to send help if possible. For the anesthesia management of the baby with CDH on ECMO, the anesthesia should consist of at least 25 micrograms per kilo of Fentanyl up to 50 micrograms/ kilo (more if baby has been on significant drip pre-op) and  Pavulon at 0.1 milligram per kilogram repeated as needed for movement and at one hour intervals. No other anesthesia is necessary and management of the hemodynamics, ventilation and oxygenation should be the same as when the baby is on ECMO and not having surgery. Replace blood as needed and adjust circuit flows to achieve oxygenation and gas flow to achieve ventilation.

Babies on HF Ventialtion too sick to go to the OR:

If an ELBW micro premie with NEC requires surgery but it is the opinion of the surgeon and the neonatology team that the infant is too fragile to tolerate the trip to the OR anesthesia has agreed to come to the NICU to support this procedure. A neonatal attending or fellow versed in the care of the infant of the HF ventilator must be present to provide support for the anesthesiology personnel. Anesthesia will consist of pavulon .1 milligram per kilogram and fentanyl 25 micrograms per kilogram. In the event anesthesia is unavailable it will be the decision of the patient care team whether to proceed with the operation in the NICU or transfer the baby to the OR.

Regarding ROP surgery that must be done in the NICU:

Anesthesia should include 10-25 micrograms of fentanyl and 0.1 milligram of paralytic plus either atropine (10 microgram per kilo) or Robinol- glycopyrolate at 10-12 micrograms per kilo (Dr Deshpande gives all his babies .25 cc of the Robinol which comes as .2 mg/cc) The atropine or Robinol is to decrease the vagal effects of the eye manipulation and can result in moderate tachycardia.