RESUSCITATION OF THE NEONATE AFTER C - SECTION ERIN SPENCER, M.ED., CVT, VTS ( ECC )
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• Pre-oxygenation via face mask should be performed for at least 5 minutes prior to induction to help combat a potential decrease in oxygenation and ventilation. The mask should not be pulled away from the patient’s face until the induction drug has been given and the person placing the endotracheal tube has the tube in hand and is able to intubate to ensure the full benefits of pre- oxygenation. If intubation is not successful on the first attempt and/ or more drugs are needed, the facemask should be returned to the patient so pre-oxygenation can continue. PHYSIOLOGIC CONSIDERATIONS OF FETUS/NEONATE 1 Oxygen saturation levels in the fetus are low relative to adult values. In addition, the clamping and severing of the umbilical cord causes a hypoxic event within the neonate which also causes an increase in vascular resistance within the neonate’s peripheral vessels. All of these factors initially cause dyspnea, which in turn causes a contraction of the chest muscles and, hence, breathing is initiated. This normal physiology can be inhibited or disrupted by several factors both while still in the fetal stage or after delivery. • In the fetal stage, aspiration of amniotic fluid, crowding in the uterus and a prematurely detached placenta can all result in hypoxia.
• Commonly neonates experience hypoxia due to an inability to inflate the lungs. This may be due to obstruction, aspiration of birth material or fluids, or may be due to a lack of surfactant needed for the lungs to expand and move within the chest cavity properly. Lack of surfactant is most commonly associated with premature births but can also be seen when suctioning during resuscitation e ff orts has been too vigorous. 2 Thermoregulation is another concern for the neonate. Upon birth, the neonate’s body temperature slowly drops from the dam/queen’s body temperature. A large surface area- to-body mass ratio, inability to shiver, and poor vasoconstriction make it di ffi cult for the neonate to maintain body temperature. It is important to provide heat support at all times for the neonates until they can be returned to the dam/queen. Heat support needs to be monitored closely because providing too much heat can put the neonate at risk for becoming hyperthermic due to their inability to pant, poor peripheral circulation, and poor coordination. 3 C-section situations create an added concern for the fetus/neonate. The blood brain barrier is immature in the fetus and results in a higher sensitivity to drugs. In addition to the blood brain barrier, all body systems are immature and are more sensitive to drugs. As mentioned earlier, pre- medication can be used if needed but
should be done so judiciously. While it is necessary to utilize induction and maintenance anesthetics to perform the necessary surgical procedure, doses should be conservative while still providing adequate anesthesia. The goal is to have minimal drug interactions within the neonate to prevent extreme resuscitation e ff orts from being necessary.
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