Neonatal Anesthesia
Explanation | Before the operation | During the operation | After the operation
What is neonatal anesthesia?
Neonatal anesthesia includes general anesthesia for term babies in the first month of life, as well as premature babies (babies born before the 38th week of pregnancy).
During surgery, anesthesiologists focus on preventing and treating:
- Apnea (when breathing stops for 10 seconds or longer)
- Meticulous fluid replacement
- Managing blood loss
- Monitoring and maintaining blood glucose levels
- Controlling temperature
- Managing pain
Hernia repair is a common procedure performed in newborns. We also do surgery for less common newborn conditions:
- Tracheoesophogeal fistula (an abnormal opening between the trachea and the esophagus)
- Necrotizing enterocolitis (damage to the intestines)
- Gastroschisis (an opening in the abdominal wall that allows the stomach and small and large intestines to protrude outside the body)
- Omphalocele [a congenital (present at birth) malformation of the abdominal wall in which abdominal contents protrude into a thin-walled sac outside of the abdominal cavity]
- Pyloric stenosis (narrowing of the lower portion of the stomach that leads to the small intestine)
- Congenital diaphragmatic hernia (part of the abdomen protrudes through the diaphragm)
Before the operation
Before giving anesthesia, we will ask questions about your baby's gestational age, birth history, history of apnea and lung disease and other problems of prematurity. We will evaluate the baby's airway, heart and lung function, any congenital abnormalities and the state of hydration.
Before surgery, we may order laboratory tests including a blood count, calcium and glucose levels and clotting studies. Newborns and premature babies are usually medicated with atropine before receiving anesthesia. This helps to dry the mouth and maintain heart rate during anesthesia.
During the operation
General anesthesia is usually provided initially by intravenous (IV) or mask technique, followed by placement of the breathing tube.
Anesthesia professionals will monitor your child closely during surgery. For hernia surgery, routine equipment will check on the heart's electrical activity, blood pressure, oxygen levels in the blood, body temperature and breathing (measuring inhaled oxygen and exhaled carbon dioxide concentrations). For more major surgery, a special blood pressure monitor (an arterial line) may be used to continuously monitor blood pressure. An arterial line is like a regular IV, but placed in an artery rather than a vein. Similarly, a central line may be used to monitor central venous pressure.
When possible, we reduce the need for anesthetic agents by using a nerve block, also called a caudal block. For hernia surgery, we give a single shot nerve block. For major surgery, we use continuous nerve blocks. These blocks are placed once your child is asleep and controls pain during and after surgery.
In order to reduce the risk of apnea after surgery in premature babies, caffeine is usually given by IV before anesthesia.
After the operation
Healthy term babies having outpatient procedures are monitored for four to six hours before going home. Depending on their age, premature babies may be admitted overnight for monitoring for apnea.
Newborns undergoing more extensive surgery are cared for in the Regional Center for Newborn Intensive Care. The breathing tube may be kept in these babies for a period of time after surgery to assist ventilation. Pain control is provided by continuous nerve block or by IV pain medications.
Contact Us
For additional information on this or any Health Topic, please call the Family Resource Center, 513-636-7606, or your pediatrician.
Rev. 10/05
