Calcium and Neonates

[KLPM]

I haven't done much paediatric anything. I am starting my paediatric rotation in a week and a large part of the program is paediatric surgery. Since I have an interest in anaesthesia I thought I had read up on some paediatric anaesthesia .

So something I keep coming across is the fact that the sarcoplasmic reticulum in neonates is under-developed and thus the their cardiac contractility is dependent upon extracellular calcium. I am just curious is this a "practical fact" or is it one of those "perpetuated truths"? When would you use calcium for neonates? Would you routinely check calcium levels preoperatively/postoperatively for neonates?

Apologies if I sound extremely dumb right about ....... now.

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[fakin' the funk]

So something I keep coming across is the fact that the sarcoplasmic reticulum in neonates is under-developed and thus the their cardiac contractility is dependent upon extracellular calcium. I am just curious is this a "practical fact" or is it one of those "perpetuated truths"? When would you use calcium for neonates? Would you routinely check calcium levels preoperatively/postoperatively for neonates?

It's practical, and it's true. Calcium is an inotrope and a vasopressor as well. Monitoring and maintaining ionized calcium levels are very important for neonatal care, probably more so than for adults, for the reasons you mentioned. So we check calciums frequently on neonate cases in the OR especially following any events that would change calcium levels (transfusion, acid-base changes).

 

[etudiante04]

It's practical, and it's true. Calcium is an inotrope and a vasopressor as well. Monitoring and maintaining ionized calcium levels are very important for neonatal care, probably more so than for adults, for the reasons you mentioned. So we check calciums frequently on neonate cases in the OR especially following any events that would change calcium levels (transfusion, acid-base changes).

This is useful. So it was not a dumb question and the OP does not have to feel dumb.

 

[periopdoc]

It's practical, and it's true. Calcium is an inotrope and a vasopressor as well. Monitoring and maintaining ionized calcium levels are very important for neonatal care, probably more so than for adults, for the reasons you mentioned. So we check calciums frequently on neonate cases in the OR especially following any events that would change calcium levels (transfusion, acid-base changes).

Thanks for the reminder. Not a dumb question at all.

- pod

 

[sevoflurane]

Calcium is a great vasopressor in the appropriate patient.

 

[Random Anesthesiologist]

It's practical, and it's true. Calcium is an inotrope and a vasopressor as well. Monitoring and maintaining ionized calcium levels are very important for neonatal care, probably more so than for adults, for the reasons you mentioned. So we check calciums frequently on neonate cases in the OR especially following any events that would change calcium levels (transfusion, acid-base changes).

It's been a while since rotating through peds anes but I remember my attending telling me about phototherapy for hyperbilirubinemia significantly lowering ionized Ca levels too, and to take care to get ionized levels if doing surgery on a neonate treated for significant jaundice (probably preterm).

I need to go look that up again. Something about lack of melatonin inhibition with phototherapy.