Principles of anaesthesia for term neonates

This article focuses on the clinical management of a child in the first few weeks of life. The physiological changes associated with maturation in this period are important but become clinically less significant as the child grows. The practical conduct of anaesthesia requires consideration of preoperative factors, including the type of surgical procedure, antenatal history, clinical information and investigation results, fasting guidelines, and the requirement for preoperative medication. A discussion with the parents, including the issues of consent, as well as the preparation of the theatre, equipment, drugs and assisting personnel need to be dealt with in advance. The choice of anaesthetic technique balances the mode of induction, the requirement for intravenous access, and the need for monitoring. The preferred analgesic regimen, as well as intraoperative factors such as positioning, ventilation, temperature control and fluid therapy also require planning. Important issues in the postoperative period include when and where to wean from ventilation and awaken from anaesthesia, what analgesia is appropriate, and how the child is to be monitored. Fluid therapy and when to return to normal feeding are often dealt with in conjunction with the surgical team. Neonates are seldom suitable for discharge on the day of surgery.