The Anesthetic Management of an Extremely Low Birth Weight Preterm Infant Weighing 710 Grams Undergoing Ligation of Patent Ductus Arteriosus: a Case Report

Objective Preterm and extrmely low birth weight infants require meticulous anesthetic care, especially for deteriorated hemodynamic status in emergency ligation of patent ductus arteriosus. Clinical presentation An 820 gram female infant, born at 29 weeks of gestation by Caesarean section for premature rupture of membranes, presented with infant respiratory distress syndrome associated with renal dysfunction. After incubation and admission to the neonatal intensive care unit (NICU), a severe patent ductus arteriosus was disclosed. Medical treatment was contraindicated, so ligation procedure was performed when she was 6 days old and weighing 710 grams. Management Temperature, ventilation, and monitoring were continuously controlled during transportation and in the main operating theatre. Cannulae were inserted bilaterally into antecubital veins and a femoral artery. Electrocardiagram (ECG), arterial pressure, preand post-ductal oxygen saturation, end-tidal CO2 and temperature were monitored. After induction of anesthesia by fentanyl at 1 microgram, atropine at 0.015 mg, atracurium at 0.5 mg, and ketamine at 1.0 mg intravenously; a gastric tube, and an esophageal stethoscope were passed and urine output was monitored. Anesthesia was maintained with sevoflurane. FIO2 was adjusted with air and oxygen. The lungs were ventilated manually with Jackson Rees apparatus. The patient was placed in the right lateral decubitus position and an incision carried out through the left thoracotomy Conclusion An understanding of the cardiovascular pathophysiology is essential for successful management of anesthesia in an extremely low birth weight preterm infant with deteriorated hemodynamic status. Chiang Mai Med Bull 2005;44(4):155-160.