Anaesthesia for neonatal surgery

Abstract

Neonatal anaesthesia has evolved considerably over the last two decades. New agents and techniques have been widely adopted by paediatric anaesthetists, allowing a renewed emphasis on minimizing, or avoiding, periods of post-operative ventilation and sedation. The newer drugs include remifentanil, an "ultra-short" acting opioid, the local anaesthetic agent levo-bupivacaine, the volatile anaesthetic agent, desflurane, and sugammadex, a relaxant reversal agent. There is also a better understanding of the pharmacology of the more established drugs. Techniques include a variety of local and regional blocks, often aided by better needles and ultrasound imaging. Ultrasound guidance has also enabled more accurate and rapid vascular access. A number of devices and instruments have enlarged the repertoire of airway management techniques available to paediatric anaesthetists, including the laryngeal mask airway, micro-cuff endotracheal tubes and small fibre-optic bronchoscopes. Forced air warming devices have proved effective in preventing hypothermia.