Epidurals, Ethics, and Expectations: Talking Risks and Benefits in Obstetric Anesthesia

Former preterm infants who present for surgery may be at increased risk for postoperative apnea. Depending on the risk of postoperative apnea, surgery may need to be delayed in order to decrease risk for apnea in the perioperative period. In cases where surgery cannot be delayed, it is important to recognize infants who are at increased risk in order to monitor these infants appropriately. Risk factors for postoperative apnea in former preterm infants include preoperative anemia (hematocrit less than 30%), history of apnea that is inversely related to gestational age and postconceptual age, and a history of apnea at home. Infants who were small for gestational age may have a decreased risk of postoperative apnea compared to infants whose birth weights were appropriate and large for gestational age. Administration of caffeine and theophylline may be used as respiratory stimulants in infants with increased risk of postoperative apnea when surgery cannot be delayed. For anemic patients, iron supplementation and delayed surgery may help to minimize the risk of postoperative apnea. Importantly, blood transfusion to treat anemia does not protect against postoperative apnea. It is prudent to monitor all infants who are younger than 50-weeks postconceptual age for at least 12 hours after surgery while some institutions admit and monitor all infants younger than 60-weeks postconceptual age for 24 hours.