Abstract：
OBJECTIVE: Necrotizing enterocolitis (NEC) is a life-threatening intestinal illness mostly affecting preterm infants, which commonly requires surgery. Anesthetic care for these patients is challenging, due to their prematurity and critical illness with hemodynamic instability. Currently, there are no guidelines for anesthetic care for these vulnerable patients. Therefore, this study aimed to describe current anesthesia practices across Europe for infants undergoing surgery for NEC.
METHODS: Cross-sectional survey study.
METHODS: Anesthesiologists working in centers where surgery for NEC is performed across Europe.
METHODS: A 46-item questionnaire assessing protocols for anesthesia practice, preoperative care, intraoperative care, postoperative care, and the respondent\'s opinion on the adequacy of anesthetic care for patients with NEC in their center.
RESULTS: Out of the 173 responding anesthesiologists from 31 countries, approximately a third had a written standard protocol for anesthetic care in infants. Three quarters of the respondents screened all patients with NEC preoperatively, and a third structurally performed preoperative multidisciplinary consultation. For induction of general anesthesia, most respondents opted for intravenous anesthesia (n = 73, 43%) or a combination of intravenous and inhalation anesthesia (n = 57, 33%). For intravenous induction, they mostly used propofol (n = 58, 44%), followed by midazolam (n = 43, 33%) and esketamine (n = 42, 32%). For maintenance of anesthesia, inhalation anesthetic agents were more commonly used (solely: n = 71, 41%; in combination: n = 37, 22%), almost exclusively with sevoflurane. Postoperative analgesics mainly included paracetamol and/or morphine. Sixty percent of the respondents (n = 104) considered their anesthetic care for patients with NEC adequate. Suggestions for further improvement mainly revolved around monitoring, protocols, and collaboration.
CONCLUSIONS: Anesthesia practice for infants undergoing surgery for NEC was highly variable. Most respondents considered the provided anesthetic care for patients with NEC adequate, but also recognized opportunities for further improvement, especially with regards to monitoring, protocols, and interdisciplinary collaboration.
METHODS: Cross-sectional survey study.
METHODS: Anesthesiologists working in centers where surgery for NEC is performed across Europe.
METHODS: A 46-item questionnaire assessing protocols for anesthesia practice, preoperative care, intraoperative care, postoperative care, and the respondent\'s opinion on the adequacy of anesthetic care for patients with NEC in their center.
RESULTS: Out of the 173 responding anesthesiologists from 31 countries, approximately a third had a written standard protocol for anesthetic care in infants. Three quarters of the respondents screened all patients with NEC preoperatively, and a third structurally performed preoperative multidisciplinary consultation. For induction of general anesthesia, most respondents opted for intravenous anesthesia (n = 73, 43%) or a combination of intravenous and inhalation anesthesia (n = 57, 33%). For intravenous induction, they mostly used propofol (n = 58, 44%), followed by midazolam (n = 43, 33%) and esketamine (n = 42, 32%). For maintenance of anesthesia, inhalation anesthetic agents were more commonly used (solely: n = 71, 41%; in combination: n = 37, 22%), almost exclusively with sevoflurane. Postoperative analgesics mainly included paracetamol and/or morphine. Sixty percent of the respondents (n = 104) considered their anesthetic care for patients with NEC adequate. Suggestions for further improvement mainly revolved around monitoring, protocols, and collaboration.
CONCLUSIONS: Anesthesia practice for infants undergoing surgery for NEC was highly variable. Most respondents considered the provided anesthetic care for patients with NEC adequate, but also recognized opportunities for further improvement, especially with regards to monitoring, protocols, and interdisciplinary collaboration.
摘要：
目的：坏死性小肠结肠炎（NEC）是一种威胁生命的肠道疾病，主要影响早产儿，这通常需要手术。对这些患者的麻醉护理具有挑战性，由于他们的早产和血液动力学不稳定的危重病。目前,没有针对这些脆弱患者的麻醉护理指南。因此,这项研究旨在描述欧洲目前接受NEC手术的婴儿的麻醉实践.
方法：横断面调查研究。
方法：麻醉师在欧洲进行NEC手术的中心工作。
方法：评估麻醉实践方案的46项问卷，术前护理,术中护理,术后护理,以及受访者对中心NEC患者麻醉护理的充分性的意见。
结果：在来自31个国家/地区的173名麻醉医师中，大约三分之一的婴儿有书面的麻醉护理标准方案.四分之三的受访者在术前筛查了所有NEC患者，和第三个在结构上进行术前多学科咨询。对于全身麻醉的诱导，大多数受访者选择静脉麻醉(n=73,43%)或静脉和吸入联合麻醉(n=57,33%).对于静脉诱导，他们主要使用异丙酚(n=58，44%)，其次是咪达唑仑（n=43，33％）和艾氯胺酮（n=42，32％）。为了维持麻醉，吸入麻醉剂更常用（单独使用：n=71，41％；联合使用：n=37，22％），几乎完全用七氟醚。术后镇痛药主要包括对乙酰氨基酚和/或吗啡。60％的受访者（n=104）认为他们对NEC患者的麻醉护理足够。进一步改进的建议主要围绕监测,协议,和合作。
结论：接受NEC手术的婴儿的麻醉实践差异很大。大多数受访者认为为NEC患者提供的麻醉护理足够，但也认识到了进一步改进的机会，特别是在监控方面，协议,跨学科合作。
方法：横断面调查研究。
方法：麻醉师在欧洲进行NEC手术的中心工作。
方法：评估麻醉实践方案的46项问卷，术前护理,术中护理,术后护理,以及受访者对中心NEC患者麻醉护理的充分性的意见。
结果：在来自31个国家/地区的173名麻醉医师中，大约三分之一的婴儿有书面的麻醉护理标准方案.四分之三的受访者在术前筛查了所有NEC患者，和第三个在结构上进行术前多学科咨询。对于全身麻醉的诱导，大多数受访者选择静脉麻醉(n=73,43%)或静脉和吸入联合麻醉(n=57,33%).对于静脉诱导，他们主要使用异丙酚(n=58，44%)，其次是咪达唑仑（n=43，33％）和艾氯胺酮（n=42，32％）。为了维持麻醉，吸入麻醉剂更常用（单独使用：n=71，41％；联合使用：n=37，22％），几乎完全用七氟醚。术后镇痛药主要包括对乙酰氨基酚和/或吗啡。60％的受访者（n=104）认为他们对NEC患者的麻醉护理足够。进一步改进的建议主要围绕监测,协议,和合作。
结论：接受NEC手术的婴儿的麻醉实践差异很大。大多数受访者认为为NEC患者提供的麻醉护理足够，但也认识到了进一步改进的机会，特别是在监控方面，协议,跨学科合作。
