Neonatology pp 383-394 | Cite as

Neonatal Anesthesia

  • Nicola DismaEmail author
  • Leila Mameli
  • Rachele Bonfiglio
  • Clelia Zanaboni
  • Pietro Tuo
Reference work entry


Administration of the anesthetic drugs, surgery and the underlying disease, can interfere with the developmental changes of the neonatal life. For this reason, it is mandatory for the pediatric anesthetist to know the pathophysiology of the neonatal age, in order to correctly apply the principles of the neonatal anesthesia. The perinatal period and the delivery provide us important details for the complete medical history, and the complete preoperative anesthetic evaluation should be focussed on the infants’ transition from the fotal to the neonatal life. Moreover, the techniques for induction and maintenance of anesthesia may vary with the infant’s size, the gestational age, medical status, and surgical procedure. Regional anesthesia is widely used for intra- and postoperative analgesia and spinal anesthesia, and it can be considered a useful alternative to general anesthesia, especially to prevent the risk of postanesthesia apnea.

Postoperative pain can be pharmacologically safely treated with opioid, paracetamol, or regional anesthesia, when handled by an experienced pediatric acute pain service.


  1. Allegaert K, van den Anker JN, de Hoon JN et al (2008) Covariates of tramadol disposition in the first months of life. Br J Anaesth 100:525–532CrossRefGoogle Scholar
  2. Allegaert K, Palmer G, Anderson B (2011) The pharmacokinetics of intravenous paracetamol in neonates: size matters most. Arch Dis Child 96:575–580CrossRefGoogle Scholar
  3. American Academy of Pediatrics, Committee on Fetus and Newborn and Section on Surgery, Canadian Paediatric Society and Fetus and Newborn Committee (2006) Prevention and management of pain in the neonate: an update. Pediatrics 118:2231–2241CrossRefGoogle Scholar
  4. American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists (2002) Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 96(4):1004–1017CrossRefGoogle Scholar
  5. Anand KJ, Barton BA, McIntosh N et al (1999) Analgesia and sedation in preterm neonates who require ventilatory support: results from the NEOPAIN trial. Neonatal Outcome and Prolonged Analgesia in Neonates. Arch Pediatr Adolesc 153:331–338CrossRefGoogle Scholar
  6. Anand KJ, Hall RW, Desai N et al (2004) Effects of morphine analgesia in ventilated preterm neonates: primary outcomes from the NEOPAIN randomized trial. Lancet 363:1673–1682CrossRefGoogle Scholar
  7. Bartocci M, Lundberg S (2007) Intravenous paracetamol: the “Stockolm protocol” for postoperative analgesia of term and preterm neonates. Pediatr Anesth 17:1111–1121CrossRefGoogle Scholar
  8. Bellu R, de Waal KA, Zanini R (2005) Opioids for neonates receiving mechanical ventilation. Cochrane Database Syst Rev 1, CD004212Google Scholar
  9. Craven PD, Badawi N, Henderson-Smart DJ, O’Brian N (2003) Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy. Cochrane Database Syst Rev (3), CD003669Google Scholar
  10. Cravero JP (2009) Risk and safety of pediatric sedation/anesthesia for procedures outside the operating room. Curr Opin Anaesthesiol 22(4):509–513CrossRefGoogle Scholar
  11. Davidson AJ, Morton NS, Arnup SJ, de Graaff JC, Disma N, GAS Consortium (2015a) Apnea after awake regional and general anesthesia in infants: the general anesthesia compared to spinal anesthesia study-comparing apnea and neurodevelopmental outcomes, a randomized controlled trial. Anesthesiology 123:38–54CrossRefGoogle Scholar
  12. Davidson AJ, Becke K, de Graaff J, Giribaldi G, Habre W, Hansen T et al (2015b) Anesthesia and the developing brain: a way forward for clinical research. Paediatr Anaesth 25:447–452CrossRefGoogle Scholar
  13. Davidson AJ, Disma N, de Graaff JC, Withington DE, Dorris L, Bell G et al (2016) Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial. Lancet 387:239–250CrossRefGoogle Scholar
  14. Disma N, Mondardini MC, Terrando N, Absalom AR, Bilotta F (2016) A systematic review of methodology applied during preclinical anesthetic neurotoxicity studies: important issues and lessons relevant to the design of future clinical research. Paediatr Anaesth 26:6–36CrossRefGoogle Scholar
  15. Loepke AW, Soriano SG (2008) An assessment of the effects of general anesthetics on developing brain structure and neurocognitive function. Anesth Analg 106(6):1681–1707CrossRefGoogle Scholar
  16. Lowery CL, Hardman MP, Manning N, Whit Hall R, Anand KJS (2007) Neurodevelopmental changes of fetal pain. Semin Perinatol 31:275–282CrossRefGoogle Scholar
  17. Madadi P, Shirazi F, Walter FG, Koren G (2008) Establishing causality of cerebral nervous system depression in breastfed infants following maternal codeine use. Paediatr Drugs 10:399–404CrossRefGoogle Scholar
  18. Mellon RD, Simone AF, Rappaport BA (2007) Use of anesthetic agents in neonates and young children. Pediatr Anesth 104:509–520Google Scholar
  19. Michel F, Constantin JM (2009) Sevoflurane inside and outside the operating room. Expert Opin Pharmacother 10(5):861–873CrossRefGoogle Scholar
  20. Ng E, Taddio A, Ohlsson A (2003) Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unit. Cochrane Database Syst Rev (1), CD002052Google Scholar
  21. Palmer GM, Atkins M, Anderson BJ et al (2008) I.V. acetaminophen pharmacokinetics in neonates after multiple doses. Br J Anaesth 101:523–530CrossRefGoogle Scholar
  22. Ranger M, Johnstone CC, Anand KJS (2007) Current controversies regarding pain assessment in neonates. Semin Perinatol 31:283–288CrossRefGoogle Scholar
  23. Saarenma E, Neuvonen PJ, Huttunen P et al (2001) Ketamine for procedural pain relief in newborn infants. Arch Dis Chil Fetal Neonatal Ed 85:F53–F56CrossRefGoogle Scholar
  24. Sammartino M, Garra R, Sbaraglia F, De Riso M, Continolo N (2010) Remifentanil in children. Paediatr Anaesth 20(3):246–255CrossRefGoogle Scholar
  25. Sanders RD, Ma D, Brooks P, Maze M (2008) Balancing paediatric anaesthesia: preclinical insights into analgesia, hypnosis, neuroprotection, and neurotoxicity. Br J Anaesth 101(5):597–609CrossRefGoogle Scholar
  26. Sun L (2010) Early childhood general anaesthesia exposure and neurocognitive development. Br J Anaesth 105(Suppl 1):i61–i68CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nicola Disma
    • 1
    Email author
  • Leila Mameli
    • 1
  • Rachele Bonfiglio
    • 1
  • Clelia Zanaboni
    • 1
  • Pietro Tuo
    • 1
  1. 1.Department of Anesthesia, Pediatric and Neonatal Intensive CareIstituto Giannina GasliniGenoaItaly

Personalised recommendations