Prise en charge anesthésique du prématuré pour chirurgie lourde : quelles particularités ?

Major surgery in preterms includes complications of prematurity itself and repair of congenital malformations. During these procedures under general anaesthesia, hypoxia, hypercapnia, acidosis, and changes in systemic or pulmonary arterial pressure may modify the shunt in a persistent ductus arteriosus. Concerning respiratory issue, high frequency oscillation ventilation is often necessary. Oxygen supply should be controlled to reduce the incidence of complications of hyperoxia, including retinopathy. Drug pharmacology in preterms is characterized by an increased volume of distribution and hepatic and renal immaturity. The pharmacokinetics of anaesthetic products is, however, poorly studied, and their influence on neuropsychological development remains debated. Monitoring of cerebral tissue oxygenation (NIRS) seems interesting in addition to the usual monitoring. Finally, these procedures must be carried out by a multidisciplinary and experienced team, in an adapted environment.