B.10. Before the planned surgery, the infant is scheduled for a magnetic resonance imaging (MRI) scan. You are asked to ensure that the baby remains immobile for 20 minutes to perform the scan adequately. How would you accomplish this?
Answer:
Because this neonate has a severely compromised airway while awake, the safest anesthetic plan to ensure immobility and adequate ventilation is to perform general anesthesia with an endotracheal tube. Any form of sedation without an endotracheal tube puts this patient at risk for complete airway obstruction. If the neonate has demonstrated a postprandial sleep cycle and can take oral fluids, it might be worth an attempt to perform the MRI scan while the neonate is swaddled in a warm baby blanket sucking on a pacifier filled with dextrose solution ("Sweetie Soother pacifier") such that the patient remains "motionless" from the inherent feeling of comfort of being able to feed and bundled in a warm blanket.
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