Anesthetic considerations in neonatal surgeries

Abstract

A term infant is born between 37 and 42 weeks of gestation and the neonatal period extends till the 28th day of life. Neonates undergoing surgical operations present several difficult challenges for the anesthesiologist. Many surgical emergencies in the neonate are life threatening and are frequently accompanied by multiple organ system failure. Safe neonatal anesthesia can only be performed with an insightful understanding of the physiological and anatomical changes taking place in the transition from fetal to neonatal life. The anesthetist should obtain good history not only for the neonate and antenatal history, but also maternal medical and surgical history. Neonates undergoing elective surgeries should be fasting 2 hours for clear fluids, 4 hours for breast milk and 6 hours for formula milk. Sedative premedication is generally not important as separation anxiety is not present in neonates. Preparation of the operating room is a cornerstone in the success of safe neonatal anesthesia. The anesthetist should prepare suitable circuits, face masks, airways, multiple-blade