SUMMARY
The simple mnemonic ABCDE summarizes the five key principles of neonatal resuscitation:
- 1
Airway
- 2
Breathing
- 3
Circulation
- 4
Drugs
- 5
Evaluation of concurrent and causative problems and maintenance of a neutral thermal environment
The simple mnemonic ABCDE summarizes the five key principles of neonatal resuscitation:
Airway
Breathing
Circulation
Drugs
Evaluation of concurrent and causative problems and maintenance of a neutral thermal environment
Provision of proper anaesthetic care to the pregnant patient with neurological disease requires a thorough understanding of the pathophysiology of the disorder and careful documentation of the patient's history and neurological examination. In most cases, regional anaesthesia can be safely administered. The anaesthesiologist should establish good rapport with the patient, while providing an adequate explanation of the known risks and benefits of the anaesthetic procedure. This should avoid any potential medico-legal complications regarding the effect of the anaesthetic on the neurological disorder. Too often, these patients are denied appropriate anaesthetic management because of these concerns. In the words of Dr J. S. Crawford: ‘Good medical practice must not be constrained or diminished by rapacious lawyers or ill-informed opinion’ (Crawford, 1983).
It is clear that pregnancy is associated with extensive functional and anatomical changes, many of which have important implications for the safe management of pain relief for labour and delivery. Some of these changes, such as increased blood volume, protect against the dangers of childbirth, while others result in diminished cardiorespiratory reserve or are associated with added anaesthetic risk. There is no doubt that pregnant women constitute a unique population which requires skilled personnel with specialized knowledge to provide for their needs.
1. Electronic fetal monitoring (EFM) can predict fetal hypoxia as defined by low Apgar scores at birth. However, the predictive value is poor in low-risk patients.
2. A normal fetal heart rate tracing is a good predictor of fetal well-being.
3. It is unclear whether EFM can prevent cerebral palsy and mental retardation.
4. Severe perinatal asphyxia, particularly in full-term infants, usually leads to neonatal demise. However, in some cases it can lead to long-term neurological handicap. In such infants, the asphyxia is usually severe and prolonged. It is usually associated with seizures, other abnormal neurological signs in the neonatal period and the long-term handicap probably always involves the motor system.
5. Studies of the aetiology of cerebral palsy and mental retardation have shown that only a small percentage of both can be attributed to perinatal asphyxia.
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