title: Ductal ligation in the very low-birth weight infant: simple anesthesia or extreme art?
abstract: Management of the very low-birth weight infant in the neonatal intensive care unit (NICU) is geared to provide optimal outcome not only in term of survival but increasingly with a goal of limitation of long-term neurological and pulmonary morbidities. Careful follow-up studies have demonstrated that relatively small variations in oxygenation and gas exchange, ventilator management, and other management modalities can have long-term consequences. Within this context, there are good data that closure of a clinically significant patent ductus arteriosus has outcome benefit, but little data on the idealized anesthetic to manage such fragile patients. Does the anesthetic management matter? Given the attention to detail within the NICU, it would seem prudent to try to choose techniques that limit changes in hemodynamics, gas exchange, and ventilation within the context of the surgery. Anesthesia for ductal ligation in the very low-birth weight infant may need to be judged by more than simple survival and brings into question the current techniques and monitoring used.
authors.affiliation: Paediatric Anaesthesia and Intensive Care, Bristol Royal Children's Hospital, Bristol, UK. andrew.wolf@nhs.net
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Wolf
mesh_terms: D000698:Analgesia; D000758:Anesthesia / Q000379:methods*; D001786:Blood Glucose / Q000378:metabolism; D002245:Carbon Dioxide / Q000502:physiology; D003422:Critical Care; D004374:Ductus Arteriosus, Patent / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000502:physiology*; D008026:Ligation / Q000379:methods*; D010100:Oxygen / Q000494:pharmacology / Q000502:physiology; D010102:Oxygen Inhalation Therapy; D059408:Pain Management; D019265:Spectroscopy, Near-Infrared
chemical_list: D001786:Blood Glucose; D002245:Carbon Dioxide; D010100:Oxygen