Ex-premature: Pulmonary Cx
The major pulmonary complication found in former -premature infants is post-operative apnea - post-operative apnea is a serious concern in the neonate, particularly if there is a history of prematurity, prior apneic episodes, bradycardia, congenital defects, anemia, or chronic lung disease (ex. respiratory distress syndrome). Infants have a lower percentage of type I fibers and are at risk for fatigue. Residual anesthetic agents may also contribute.
Consider a spinal or regional technique in these infants – one prospective, randomized study of 36 former premature infants showed a reduction in apnea from 36% to 0%. A smaller study of 18 ex-premature infants showed no change in central apnea in spinal vs. GA, but the GA cohort had lower minimum HR and SpO2 values. Note that the addition of sedation (ketamine) to spinal anesthesia in the Welborn study significantly worsened the incidence of apnea