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.
- Bellu R, de Waal KA, Zanini R (2005) Opioids for neonates receiving mechanical ventilation. Cochrane Database Syst Rev 1, CD004212Google Scholar
- 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
- 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
- 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
- Mellon RD, Simone AF, Rappaport BA (2007) Use of anesthetic agents in neonates and young children. Pediatr Anesth 104:509–520Google Scholar
- 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