airway management- neonates (neonatal resuscitation) chakafa n k (clinical anaesthetist)
TRANSCRIPT
AIRWAY MANAGEMENT- NEONATES (Neonatal Resuscitation)
CHAKAFA N K(Clinical Anaesthetist)
Introduction
• At least 10% of all newborns require some assistance at birth ie the initial steps of resuscitation
• And 1% require extensive resuscitation• There are 1 million deaths per year resulting
from Birth asphyxia(WHO,1995)• A significant number will have respiratory
problems and a large number will have seizures and later problems such as cerebral palsy.
Definitions
• Airway mgt is a process of ensuring thati) there is an open pathway between patient’s
lungs and the outside world ii) The lungs are safe from aspiration. Neonate – baby less than 28 days
Neonates compared to older children
• Neonates are small• Large surface area to weight ratio• Born wet so they are prone to rapid
evaporative heat loss• New born babies are in transition from
placental to pulmonary respiration• Large tongue• Proportionally large head and occiput
Essential equipment for resuscitation of the newborn
• Firm flat padded resuscitation surface• Source of warmth( overhead heater, warm dry
towels,radiator,hot water bottle wrapped in towels.• Clear plastic bags for preterm babies under 30wks• Good light source• Clock or timer to record time of birth, assessment and response
to resuscitation• Airway equipment: facemask 0 and 1,oropharyngeal airway size
000,00 and 0, self inflating bag with reservoir, neonatal face masks, laryngoscope and blade with spare bulb Miller (1,0), Mackintosh blade(1,0) , tracheal tubes (2.5 ,3 for pre term and 3.5 or 4 for term, stylets, size 1 LMA
Equipment cont’d
• Nasogastric tube• Adhesive tape • Oxygen • Stethoscope to assess HR and breath sounds• IV cannulae, 24 g, umblical catheter• Drugs : N/saline, adrenaline 1:10000,10%
glucose, sodium bicarbonate,naloxone
Assessment
Was th e baby born after full term gestation?Is the amniotic fluid clearof meconium and
evidence of infection?Is the baby crying?Does the baby have a good muscle tone?
Healthy child
• If the answer to all 4 of these questions is “yes” then there is no need for any resuscitation
• Do not separate the child from the mother• Dry the baby, place onto the mother’s chest• Cover the child with a dry cloth• Observation of breathing , activity and colour
should be ongoing
Asphyxiated baby
• If the answer is “no” then the child is in danger, so the child should receive one or more of the following :
i) Initial steps in stabilization(provide warmth, position, clear airway, dry, reposition)
ii) Ventilationiii) Chest compressionsiv) Administration of epinephrine and /or volume
expansion
Heat Loss
• Minimise heat loss especially in pre term babies
• Warm towels, dry the child as soon as possible• Change towels • Place the child under a radiant heater• This must be done in 20 – 30 seconds
Airway
• Maintain head in neutral position with face parallel to the surface on which the baby is lying
• Avoid overextension/ flexion of the neck• Provide a jaw thrust • Oropharyngeal airway may be helpful- large
tongue
Meconium aspiration
• Some babies may pass meconium in utero• Inhalation of meconium before birth or during
birth can cause severe pneumonitis.• Remove any thick particulate by means of a
large bore suction device or a penguin• Do not suction the nose before the mouth- this
will stimulate the baby to gasp and to aspirate pharyngeal secretions
• Intubation is necessary in a floppy child.
Ventilation
• Ventilate the lungs with either room air or 100% oxygen
• Well fitting mask to the nose and mouth• Inflate the lungs with at a pressure of around
30cm of water• Aim at inspiratory time of 2-3secs• Give at least 5 inflations
Circulation
• Re evaluate HR• If HR is above 100 then it’s a firm indication
that lungs are adequately aerated• Assess chest movement• If HR has not improved ---- START CHEST
COMPRESSIONS
Chest compressions
• Indicated for a HR that is less than 60 despite adequate ventilation
• Necessary to bring oxygenated blood from the lungs back to the coronary arteries
• Both hands encircling the chest• Place thumbs together centrally over the lower
sternum• Rate- 120/min• For every 3 compressions give one breath aiming at 40
breaths/min
Assessment
• Look for response after 30-60secs of chest compressions
• If HR is above 100 then it indicates that you are succeeding
• However if the HR has not improved or is absent then consider DRUGS
Drugs
• Epinephrine 1:10000 0.1-0.3ml/kg IV• Epinephrine 1:10000 0.5 1ml/kg per ET• Give ET only while IV access is being established• Repeat every 5 minutes• Caution- higher doses in newborns may result in
brain and heart damage.• Sodium bircabonate (4,2% soln) 2mEq/kg IV over
2 min if severe metabolic acidosis is suspected
Post resuscitation care
• Glucose – 10% dextrose water 2ml/kg iv• Phenobarbital (seizures) 20mg/kg slow iv• Dopamine(hypotesion)- 2- 20mcg/kg
Discontinuing Resuscitative Efforts
• Infants without signs of life i.e. no heart beat and no respiratory effort after 10min of resuscitation
THANK YOU FOR YOUR TIME