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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Technological progress contributed to progress in surgery on the newborns. However, despite the progress in surgery and intensive care of the newborns, the results of treatment of patients with congenital defects are sometimes disappointing. The priority problems for today are the respiratory distress syndrome, hemodynamic disorders, and renal dysfunction, which can be united into the syndrome of general dysadaptation of the newborns. Based on experience gained in the treatment of newborns in pediatric surgical hospital, protocols of treating newborns with developmental defects (congenital diaphragmatic hernia, esophageal atresia, and gastroschisis) have been developed. These protocols are a stage and a prerequisite for development of more effective methods for treating such patients. Common intensive care should be supplemented by such important measures as maintenance of adequate temperature regimen at all stages of medical transportation and therapy of a newborn, obligatory preoperative preparation for stabilization of vital functions, multicomponent endotracheal anesthesia, use of inotropic agents (dopamine and dobutrex), synchronic prolonged artificial ventilation of the lungs and prolonged analgesia, limitation of indications to the use of blood preparations and wide use of hydroxyethylated starch solutions in infusion therapy, rational antibiotic therapy with constant monitoring of the microecological status, and early detection and correction of concomitant diseases. Solution of these problems will essentially decrease the postoperative mortality of newborns with developmental defects.
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PMID:[Ways to reduce mortality of newborns with developmental defects]. 1199 91

Esophageal atresia is a relatively common congenital malformation occurring in 1:3000-4500 live births. Improvement in surgical, anesthetic and neonatal care has achieved a survival rate near 100% in infants weighing over 1500 g and having no major cardiac problem. To achieve these outcomes, as well as a good surgical technique, careful preoperative management (early diagnosis, investigation of associated anomalies, suction of the upper pouch, prevention and treatment of gastric and bowel distension) and accurate postoperative care (postoperative analgesia and ventilation, management of trans-anastomotic and chest tube, prevention, early recognition and treatment of complications) are mandatory.
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PMID:Esophageal atresia: pre and post-operative management. 2194 81

The aim of this paper is to describe and evaluate the benefits of epidural anesthesia in major surgery neonatal. We have performed a matched case-control (2:1) study of patients undergoing neonatal major surgery (NMSs) who received intra-and postoperative epidural anesthesia (EA) and controls with conventional general anesthesia. The matching criteria were age, weight and baseline pathology. EA was administered by caudal puncture and epidural catheter placed with ultrasound support. Levobupivacaine was selected as anesthetic drug. The time to extubation, intestinal transit time, type of analgesia and complications were studied. This study is based on 11 cases (2 esophageal atresia, 2 diaphragmatic hernias, 1 necrotizing enterocolitis, 3 intestinal atresia, 2 anorectal malformation and 1 bladder exstrophy) and 22 controls. We observed statistically significant differences in time to extubation (95% CI OR 12 1.99 to 72.35; Chi2 p = 0.004, Mann U Whytney p = 0.013) and intestinal transit time (Mann Whitney U p < 0.001, 100 Or, 95% CI 8.06-1 239; Chi2 p < 0.0001). There were no complications from epidural analgesia. Therefore we believe that the intra-and postoperative EA helps improve postoperative management in neonates and should be preferred in centers where this technique is available.
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PMID:[Benefits of epidural analgesia in major neonatal surgery]. 2348 12