Anaesthesia for specialist surgery in infancy

The provision of safe anaesthesia for neonates and small infants requires a basic understanding of neonatal physiology and pharmacology. Most surgical neonates present in the first week of life when the transitional physiology of the newborn is at its most vulnerable. The pathophysiology of the surgical condition may have a significant impact on the perioperative management and on the conduct of the anaesthesia. Congenital defects seldom occur in isolation, some occur in recognized patterns while others may be sporadic mutations. All possible defects should be excluded as part of the preoperative assessment. This article highlights the clinical presentation, the preoperative preparation and some of the problems of management associated with oesophageal atresia, gastroschisis, omphalocele, necrotizing enterocolitis, pyloric stenosis, intestinal obstruction of the newborn, congenital lobar emphysema, patent ductus arteriosus, and inguinal hernia.