الفهرس | Only 14 pages are availabe for public view |
Abstract Oesophageal atresia is a congenital obstruction of the oesophageal lumen, with 92% of patients having a tracheo-oesophageal fistula (TOF). The incidence is 1 in 3500 live births. Various surgical classifications, anatomical classifications, and prognostic classifications help predict morbidity and mortality rates. The two primary surgical techniques for TOF/OA repair are thoracoscopic and conventional open thoracotomies. Thoracoscopy is slightly invasive and reduces musculoskeletal sequelae, but may cause desaturation and reduced venous return. The open technique is preferred in many centers due to limited equipment and trainingotal open repair may only require oesophageal anastomosis and fistula ligation in a single stage. However, one lung ventilation may be necessary if the fistula is at the carina level, causing hypoxemia, hypercarbia, and increased pulmonary vascular resistance. Postoperative severe pain is a major complications, as neonates’ pain expression is not within the International Association for the Study of Pain’s strict definition. This lack of self-report makes it harder for medical personnel to identify and treat pain in infants and young children aggressively. Pain in neonates develops anatomical, neurophysiological, and hormonal components by late gestation. Infants born preterm and at term exhibit similar or heightened physiological and hormonal reactions to pain. Early pain may exacerbate affective and behavioral reactions in term newborns.. Several validated pain measures exist to assess acute pain in term and preterm neonates. These measures include behavioral indicators and physiological indicators to manage stress and pain. Common measures include PIPP, CRIES and NIPS. |