Anesthesia

Over the past 70 years or so, provision of anesthesia for the

neonate requiring surgery has developed frombeing a relatively

haphazard affair to achieving the status of a recognized

subspecialty. The improved survival rates seen following

surgery, where even the smallest and sickest infants are

concerned, have been due in no small part to advances in

anesthetic management. Equally important has been an

increased appreciation of the need for an efficient smooth-

working team. The success of neonatal surgery depends on

maximum cooperation between surgeon, anesthetist, neona-

tologist, and nursing and paramedical personnel. It is appro-

priate therefore that everyone involved in the care of neonates,

whether working inside or outside the operating theater,

should be familiar with the basic techniques used in main-

taining a favorable physiologic milieu in the face of surgical

intrusion, while at the same time ensuring adequate anesthesia.

This chapter will consider the preoperative evaluation and

preparation of the surgical neonate, anesthetic equipment,

choice of anesthetic agent and technique (with reference to the

pharmacology of the newborn), induction of anesthesia

and endotracheal intubation, maintenance and reversal of

anesthesia, perioperative monitoring and fluid therapy, the

anesthetic implications of congenital anomalies and, finally,

specific considerations for the premature infant undergoing

surgery.