Neonatal Anaesthesia

Abstract

The techniques of neonatal anaesthesia detailed in this chapter reflect the practice at the Hospital for Sick Children in London where approximately 500 newborns undergo surgery each year. Surgery is usually to correct congenital disease, often life-threatening and commonly in babies born prematurely or of low birth-weight. The development of sophisticated transport systems for newborns means that sick babies can be moved to regional Centres for neonatal surgery where expertise exists to treat such conditions as congenital diaphragmatic hernia or tracheo-oesophageal fistula. The reserves of all physiological systems of the newborn are limited so respiratory, cardiac or renal failure may be a sequel to any surgical condition at this age. An immature liver and central nervous system make the baby very sensitive to all anaesthetic drugs. Techniques using specialized equipment almost always involve intubation and controlled ventilation using nondepolarizing relaxants and small doses of inhalational agents. All techniques of intraoperative monitoring apply equally to the neonate and for the preterm baby care must be taken to limit arterial oxygenation to prevent damage to the developing retina. Pre- and postoperative monitoring must involve detection of apnoea, changes in blood volume and maintenance of body temperature and blood sugar levels. Intraventricular cerebral haemorrhage is a risk associated with prematurity, surgery and anaesthesia, but with care the risk can be minimized so that the child may develop without handicap.