How is Anesthesia Used During Neonatal Surgery?
Neonatal anesthesia includes general anesthesia for term babies in the first month of life, as well as premature babies (born before the 37th week of pregnancy). The first 30 days after birth are the time when most congenital and genetic defects are discovered and when babies are most susceptible to birth-acquired infections.
During surgery, anesthesiologists focus on:
- Preventing and treating apnea (when breathing stops for 10 seconds or longer, a condition more common in neonates and former premature infants)
- Meticulous fluid replacement
- Managing blood loss
- Monitoring and maintaining blood glucose levels
- Controlling temperature
- Managing pain
Some Conditions Requiring Surgery
Hernia repair is a common procedure performed in newborns. We also do surgery for less common newborn conditions:
- Tracheoesophageal fistula (an abnormal connection 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 (a portion of the abdominal contents protrudes through the diaphragm into the chest cavity)
Before the Surgery
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. We will also ask you about any family history of problems with anesthesia.
Before surgery, we may order laboratory tests including a blood count, kidney profile, calcium and glucose levels and clotting studies. We will review relevant imaging studies and consult with other physicians as needed.
During the Surgery
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 or to give blood or medications quickly to the central circulation.
Options for post-operative pain relief include IV narcotics and regional anesthesia such as a caudal block. For major surgery, we may use continuous nerve blocks. These blocks are placed once your child is asleep to control pain during and after surgery.
To reduce the risk of apnea after surgery in premature babies, caffeine may be given by IV before or during anesthesia.
After the Surgery
Healthy full-term babies older than 1 month of age may be able to go home the same day they have surgery. Depending on their age, premature babies and some term babies (less than 1 month of age) may be admitted overnight for monitoring. This is due to the increased risk of apnea, or breath holding, that can occur after general anesthesia.
Newborns undergoing more extensive surgery are cared for in the Newborn Intensive Care Unit. 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.
