Ketamine–Fentanyl Anesthesia in a Low-Birth-Weight Neonate with Duodenal Atresia and Annular Pancreas: An Observational Analytic Study

Abstract

Background. Low-birth-weight neonates with duodenal atresia and annular pancreas may have perioperative cardiovascular and metabolic instability.

Objective. To describe the perioperative course of a neonate managed with a volatile-sparing ketamine–fentanyl anesthetic regimen.

Methods. An observational case study followed a 4-day-old male infant weighing 1,800 g, born at 37 weeks with intrauterine growth restriction. A 12-hour fluid resuscitation period preceded laparotomy. Induction used intravenous ketamine (2.8 mg/kg) and fentanyl (2.8 mcg/kg), followed by pressure-controlled ventilation, fluid replacement and postoperative intensive care.

Results. After resuscitation, potassium increased from 3.1 to 3.9 mmol/L and chloride from 92 to 98 mmol/L. During surgery, heart rate was 135–158 beats/min and mean arterial pressure was 48–54 mmHg, without inotropic support. Estimated blood loss was 10 mL, below the reported allowable blood loss of 26 mL. Postoperative ketamine infusion (0.2 mg/kg/h) was discontinued at extubation on postoperative day 2. Enteral feeding began on day 4, and the infant was discharged on day 21.

Conclusion. The reported course illustrates perioperative management with a volatile-sparing regimen following metabolic correction. A single case cannot establish causal benefit or comparative superiority.