Post-operative Care
- After tight abdominal closure, compliance falls — most neonates are left intubated for elective post-operative ventilation and weaned in NICU.
- Continue warming, glucose control, analgesia (multimodal, opioids titrated) and fluid/haemodynamic support.
- Ongoing surveillance for abdominal compartment syndrome, sepsis and bowel ischaemia; monitor urine output, lower-limb perfusion and airway pressures.
Complications: abdominal compartment syndrome, bowel necrosis/perforation, necrotising enterocolitis, sepsis, prolonged ileus & TPN dependence, hepatic impairment, hypothermia and blood loss.
Common Mistakes
Using nitrous oxide — distends the bowel and defeats the reduction.
Vigorous mask positive-pressure ventilation at induction → gastric/bowel distension; not decompressing the stomach first.
Letting the neonate get cold — hypothermia worsens acidosis, coagulopathy and drug handling.
Pushing for primary closure despite rising airway/intragastric pressures → compartment syndrome; a silo is safer.
Viva-Ready Pearls
Gastroschisis = no sac (para-umbilical, right of cord); omphalocele = sac + associated anomalies.
Avoid N₂O; treat as full stomach → RSI; atracurium; keep warm; give glucose.
Stage the closure if intragastric/intravesical pressure > 20 cmH₂O, PIP > 35 cmH₂O, or EtCO₂ > 50 mmHg.
Titrate fluids to urine output 1–2 mL/kg/h; Hb goal ~10–12 g/dL.
References
- Dr. Tanya Chawla — case notes on Gastroschisis.
- Coté & Lerman — A Practice of Anesthesia for Infants and Children.
- Gregory's Pediatric Anesthesia — Neonatal surgical emergencies / abdominal wall defects.
- Miller's Anesthesia — Anesthesia for the neonate.