title: [Anesthetic problems in a 480 g infant for ventriculo-peritoneal shunt surgery].
abstract: A 480 g, 38-day-old female infant underwent ventriculo-peritoneal shunt surgery for hydrocephalus after intra-ventricular hemorrhage. The patient was born at a gestational age of 25 weeks and 5 days, weighing 600 g, as one of twins by a cesarean section. Although respiratory distress syndrome developed, it was relieved with surfactant. The esophagus was easily perforated by a gastric tube. At the age of 7 days, PDA was closed conservatively with indomethacin. Anesthesia was induced and maintained with fentanyl (induction dose 4 micrograms.kg-1, total dose 6 micrograms.kg-1) and vecuronium. Ventilation was controlled with oxygen and air (FIO2 0.21-0.25). The main problems encountered by anesthetists in the perioperative period were; fluid management (hyperkalemia, hyponatremia, infusion volume), bradycardia due to increased intracranial pressure, body temperature control (hypothermia), and transport to the operating room. In anesthesia for extremely low birth weight (extremely premature) infants, utmost care and proficient procedure are required because of their immaturity, fragility and smallness.
authors.affiliation: Department of Anesthesiology, Juntendo University School of Medicine, Tokyo.
authors.forename: A
authors.initials: A
authors.lastname: Mizushima
authors.forename: H
authors.initials: H
authors.lastname: Sakai
authors.forename: K
authors.initials: K
authors.lastname: Hanzawa
authors.forename: Y
authors.initials: Y
authors.lastname: Horimoto
authors.forename: T
authors.initials: T
authors.lastname: Kugimiya
mesh_terms: D000759:Adjuvants, Anesthesia; D000758:Anesthesia / Q000379:methods*; D002543:Cerebral Hemorrhage / Q000150:complications; D005260:Female; D005283:Fentanyl; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D014673:Vecuronium Bromide; D017287:Ventriculoperitoneal Shunt
chemical_list: D000759:Adjuvants, Anesthesia; D014673:Vecuronium Bromide; D005283:Fentanyl