Complex Challenges in Perioperative Care of a Preterm Neonate: A Case Report

Background Perioperative management of extremely preterm neonates presents significant challenges due to their fragile physiological status, including respiratory instability, cardiovascular vulnerability, and metabolic immaturity. This case report details the complex perioperative care of a 22-day-old male neonate, born at 27 weeks of gestation, who required surgical intervention for an incarcerated inguinoscrotal hernia. Case Presentation The neonate with post conception age of 30 weeks, born weighing 1.225 kg, presented with a right scrotal swelling diagnosed as an incarcerated inguinoscrotal hernia. His early postnatal course was complicated by respiratory distress syndrome (RDS), necessitating mechanical ventilation and surfactant therapy. A multimodal, opioid-free anaesthesia regimen was conceived to minimize the risk of postoperative apnoea. Intraoperative care focused on maintaining stable oxygenation, normothermia, and hemodynamic parameters. Anaesthesia was induced using ketamine and maintained with mixture of air/Oxygen and Sevoflurane. Ultrasound guided caudal block with Levo bupivacaine was administered to address perioperative pain. The neonate was ventilated intraoperatively in pressure-controlled mode and postoperatively in P-SIMV mode, with a smooth transition to CPAP and then to room air. The patient recovered without complications, demonstrating the effectiveness of the anaesthetic strategy employed. Conclusion This case highlights the complexities of perioperative management in extremely preterm neonates, emphasizing the importance of an individualized, multidisciplinary approach. The successful outcome underscores the efficacy of opioid-sparing anaesthesia and meticulous perioperative care in mitigating the risks associated with surgery in these vulnerable preterm neonates. This report contributes to the growing body of knowledge on optimizing perioperative strategies for preterm neonates.