Anaesthetic management of a case of neonatal tetanus undergoing laparotomy for intestinal obstruction
AbstractAim: To highlight the importance of committed efforts in pre- and postoperative anaesthetic management of very ill neonates.
Case Report: General anaesthesia was administered for laparotomy in a five day old baby boy with intestinal obstruction and neonatal tetanus, who had an anaesthetic risk of (ASA) 4E. Ante-natal care and delivery were carried out by a traditional birth attendant. He was resuscitated with 4.3% dextrose in 0.18 saline until stable pulse, blood pressure and urine output were achieved over a six hour period. Antibiotics and anti-tetanus therapy were started in the ward.
The patient was given a diazepam based general anaesthesia with muscle relaxation and manually ventilated with 70% oxygen in air. Oxygen saturation, pulse, temperature and blood pressure were maintained at stable levels during the operation which lasted two and half hours. Early recovery of spontaneous respiration was encouraged, in the absence of ideal postoperative respiratory support.
Manual respiratory assistance was continued for another 5hrs postoperatively before spontaneous respiration was judged adequate. Supplementary oxygen via the nasal catheter was continued until his discharge to the ward on the 23rd day.
Conclusion: When surgery is the best management option, the patient should not be too ill for it. It is, however, important that the best achievable clinical condition within the safe moments be realized.
Keywords: neonate, hernia, tetanus, anaesthesia
Orient Journal of Medicine Vol. 17(3&4) 2005: 1-6