Neonatal anesthesia

Abstract

The neonate presents with some of the greatest challenges that anesthesiologists must face in clinical pediatric practice. Special anatomy, adaptive physiology, developmental pharmacology, and congenital as well as acquired pathology combine to produce a very complex set of conditions that the anesthesiologist must address. Medical and technological advances have pushed the gestational age at which preterm neonates are viable closer and closer to the 20-week date.':” As a consequence, small size has added a serious technical challenge for anesthesiologists. In the past decade, our understanding of physiology and pharmacology as they relate to the neonate together with innovative technology have dramatically increased the margin of safety when anesthetizing neonates. Despite these innovations, perioperative morbidity and mortality in the neonate remain greater than in any other pediatric age group.” This chapter summarizes the salient considerations that the practicing clinician must master by merging the developmental changes in the neonate with scientific and technological innovations.