الفهرس 
Neonatal respiratory systemOnly 14 pages are availabe for public view
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Abstract
Neonatal Anesthesia is a highly dynamic field . New areas of research are continuously evolving . New treatment modalities that are previously considered technically unfeasible like foetal surgeries are now a working reality. The advent of new surgical treatment modalities have widened the possibilities of treatments which in turn would pose more challenges to the anesthesiologist.
In addition experience gained and knowledge subtracted from various randomized controlled trials and the meta-analysis of previous studies have led to the advancement in anesthetic care for the neonate and has rendered some of the hitherto considered emergent surgical conditions into urgent ones.
This is Primarily achieved through advancement in peri-operative medical stabilization strategies, the introduction of minimally invasive techniques and the introduction of recent technology , which promise new vistas for the preservation of the neonate and is reflected on the morbidity and mortality outcomes.
The understanding of the control of breathing during the perinatal and early postnatal periods has increased significantly. In young infants, hypoxemia is a potent respiratory depressant, rather than a stimulant . because of immaturity of respiratory control mechanisms , these infants often develop periodic breathing without apparent hypoxemia, and occasionally they experience central apnea with possible serious consequences. The lungs are immature at birth, even in full-term infants. Most alveolar formation and elastogenesis occur postnatally during the first year of life. Thoracic structure is insufficient to support the negative pleural pressure generated during the respiratory cycle. In addition Anesthesia diminishes or abolishes the compensatory mechanisms and the end expiratory lung volume decreases to the point of airway closure, resulting in widespread atelectasis.
Regional anesthesia may reduce the liability for apneic spells. Regional anesthesia is particularly advantageous for an infant who is recently weaned from ventilator dependency and who may also have some residual sequalae of endotracheal intubation.
Rather than “rushing” to close the Abdominal wall defect, careful assessment of associated defects, establishing smooth cardiorespiratory transition, and ensuring adequate intravascular volume comprise the critical aspects of modern perioperative management.
The drastic improvement in the operative mortality rate of CDH has apparently resulted from the new strategy of delaying surgery, neonatal stabilization, and the adaptation of new a lung-protective, or “gentle ventilator,” strategy with a small tidal volume, a higher and adequate positive end-expiratory pressure (PEEP) to keep the airways open, and the acceptance of the resultant rise in Pco2 (permissive hypercapnea).
Intestinal obstruction has historically been one of the major causes of death after neonatal surgery. With more skilled pediatric management and the development of parenteral alimentation, mortality is now limited primarily to infants whose condition is diagnosed late and who require extensive excision of the small and large bowels.
Congenital high airway obstruction syndrome (CHAOS) and airway reconstruction: is an evolving paradigm. Made possible by the advent of the exit procedures.
Stabilization of infants with PGE1 in infants suffering complete IAA allows for time to optimize the patient’s hemodynamic state before surgery. The prognosis, before which even short term survival of infants was highly unlikely and the condition was considered uniformly fatal.