ABSTRACT

This chapter proposes the maintenance and reversal of anesthesia. The cornerstone of preoperative anesthetic management is a detailed knowledge of the infant's history combined with a thorough physical examination. The prime objectives of neonatal anesthesia are the provision of sleep, analgesia, life support, intensive surveillance, and appropriate operating conditions for the infant requiring surgery. In order for these to be achieved, it is imperative that both operating theater environmental conditions and anesthetic equipment be appropriate. Because of the anatomical peculiarities of the infant's airway, most anesthetists prefer to use a laryngoscope with a straight blade, lifting the epiglottis forward from behind to facilitate intubation. Inhalation induction of anesthesia with either air or nitrous oxide, oxygen, and a volatile agent remains popular. Halothane was, for many years, the most widely used volatile anesthetic for inhalation induction in infants and young children. This is largely because it is usually associated with a smooth induction without irritant effects on the airway.