Principles of anaesthesia for term neonates: an updated practical guide

Term neonates present for various surgical procedures, many of which are urgent and are probably best cared for in specialised paediatric centres where expertise is concentrated. Pathophysiological derangements caused by the underlying condition, associated congenital anomalies and immaturity of key physiological and metabolic processes all contribute to make anaesthesia especially challenging in the neonate. For these reasons, anaesthesia-associated morbidity and mortality is greater in this group than in older infants and children. Meticulous attention to all aspects of perioperative care is vital to ensure the best possible outcome. The principles of safe practice of anaesthesia for term neonates are outlined in this article, which excludes neonatal cardiac surgery and the details of neonatal pain management. Finally, the potentially deleterious effects of general anaesthetics on the developing brain are discussed.