Prevention of pain in neonates is critical because of the potential for harmful consequences. Neonatal anesthetic management requires an understanding of the pharmacophysiologic limitations of the neonate as well as the pathophysiology of coexisting surgical disease.1 Although some neonates are extremely resistant to anesthesia, they are able to stand surgery for a fairly long period. However, there are numerous factors to consider, including:
- Anemia and dehydration
- Induction of anesthesia, maintenance with or without an endotracheal tube, and positions of the patient
- Blood pressure and pulse
- Optimum temperature of the theatre and postoperative room2
Use the resources in this section to learn more about optimal management of anesthesia in neonates.
Videos and Lectures
- Neonatal Anesthesia - Hillier
By Permission: SEMINARS IN PEDIATRIC SURGERY, Vol 13, 2004, pp142-151
Multisystem immaturity creates important developmental differences in drug handling and response when compared to the older child or adult.
- Anesthesia ventilators: better options for children
Mechanical ventilation of pediatric patients in the operating room is challenging. Infants require significantly smaller tidal volumes than adults and changes in delivered volume that would be clinically insignificant for an adult patient, can produce unintended hyper- or hypoventilation in children.
- Oxygen in Neonatal Anesthesia- Friend or Foe
Clinical practices in oxygen administration are in need of change based on the increasing understanding of oxygen toxicity.
- Problems of Neonatal Anesthesia
As the neonates are strikingly different from the adults regarding anatomy and pysiology, many problems arise during anesthesia and postoperative period.
- Neonatal Anesthesia- Committee on Fetus and Newborn
In the past, some practicing physicians have advocated withholding anesthetic or analgesic agents from neonates undergoing surgical procedures.
- Prevention and Management of Pain in the Neonate - An Update-P2009
The prevention of pain in neonates should be the goal of all caregivers because painful exposures have the potential for deleterious consequences.
- Ward Reduction without General Anaesthesia Versus Reduction and Repair Under General Anaesthesia for Gastroschisis in Newborn Infants
To determine which approach to the immediate surgical treatment of gastroschisis has the better outcomes: ward reduction without general anaesthetic or reduction and repair of the abdominal wall defect under general anaesthesia.
- Sucrose for analgesia in newborn infants undergoing painful procedures
Administration of oral sucrose with and without non-nutritive sucking is frequently used as a non-pharmacological intervention for procedural pain relief in neonates.
- Regional (spinal, epidural, caudal) Versus General Anaesthesia in Preterm Infants Undergoing Inguinal Herniorrhaphy in Early Infancy
To determine if regional anaesthesia, in preterm infants undergoing inguinal herniorrhaphy, reduces post-operative apnoea, bradycardia, and the use of assisted ventilation, in comparison to those infants undergoing inguinal herniorrhaphy with general anaesthesia.
- Prophylactic Caffeine to Prevent Postoperative Apnea Following General Anaesthesia in Preterm Infants
To determine the effect of the prophylactic use of caffeine to prevent episodes of apnea, cyanosis and bradycardia during the postoperative period in ex-preterm infants who undergo general anesthesia for surgery.
- Naloxone for Preventing Morbidity and Mortality in Newborn Infants of Greater than 34 Weeks Gestation with Suspected Perinatal Asphyxia
Studies in animal models have suggested that naloxone, a specific opiate antagonist, may improve outcomes for newborn infants with perinatal asphyxia.
- Naloxone for Opiate-Exposed Newborn Infants
To determine the effect of naloxone on the need for or duration of ventilatory support or neonatal unit admission in newborn infants who have been exposed in-utero to narcotics.
- Intravenous Midazolam Infusion for Sedation of Infants in the Neonatal Intensive Care Unit
Proper sedation for neonates undergoing uncomfortable procedures may reduce stress and avoid complications. Midazolam is a short acting benzodiazepine that is increasingly used in neonatal intensive care units (NICU).
- Sucrose Analgesia for Simple Neonatal Procedures
Neonates feel pain as intensely as adults. Oral Sucrose has been shown to be an effective and safe treatment for reducing the pain response of neonates.
- Pharmacological Therapy for Analgesia and Sedation in the Newborn
Rapid advances have been made in the use of pharmacological analgesia and sedation for newborns requiring neonatal intensive care.
- Evaluation and Development of Potentially Better Practices to Improve Pain Management of Neonates
Despite increased knowledge, improved options, and regulatory mandates, pain management of neonates remains inadequate, promoted by the ineffective translation of research data into clinical practice.
- Can Volume Controlled Ventilation Re-emerge Pediatric Anesthesia-P2009
Modern anesthesia ventilators have been designed to consistently deliver accurate Vt (tidal volume) during volume controlled ventilation (VCV) even to very small patients.
2. Kundu N, Roy BP. Problems of neonatal anesthesia. Indian J Pediatr.1986;53(2):237-241.