tion (MAC) is an estimate of anesthetic requirements and changes with age [8, 11]. Infants up
to 6 months of age require higher MAC value than older neonates [8]. Volatile anesthetics cause
dose‐dependent cardiac and respiratory depressant effect in neonates. These effects can cause
bradycardia, hypotension, and postoperative apnea. This hypotensive effect is more likely in
preterm and term neonates than older children, especially in the induction period.
In contrast, an opioid agent causes fewer hemodynamic changes, but it should be noted that
increase the risk of postoperative apnea in preterm and term neonates [2].
In the last 15 years, effects of general anesthetic agents on brain development have made a
great progress. The recent animal studies have demonstrated that general anesthetics (espe‐
cially these acting through the N-methyl-D-aspartate (NMDA) and Gama aminobutyric acid
(GABA) receptors) can be responsible from neuronal cell death and deterioration of brain
development especially immature brain [13]. It is reported that this effect is to be related to
drug dosages and exposure time. Many factors affect brain maturation apart from anesthesia.
Dinardo et al. emphasized that neuroanatomic abnormalities preexist in neonatal patients with
complex congenital cardiac pathologies. The retardation of brain maturation has been
observed in these patients [14]. Long‐term neurobehavioral effects of sedative and anesthetic
agents should be supported by long‐term human studies.
3.2. Monitoring
Basic monitorization should include heart rate‐electrocardiograph, pulse oximetry, blood
pressure, and temperature in neonates. Two oxygen saturation probes must be plugged
(preductal and postductal probes). This approach is intended to evaluate possible PDA‐
mediated shunt development. Invasive arterial blood pressure and central venous pressure
can be monitored in special circumstances such as expected ventilation‐perfusion and
hemodynamic changes and acid‐base imbalance.
Precordial‐esophageal stethoscope is a very useful method in neonatal monitoring. With this
method, changes in heart rate and respiratory parameters can be identified in the early phase.
Although end‐tidal carbon monoxide monitorization is a routine application, increase in dead
space in the breathing system can cause false and inaccurate measurement in infants.
4. Anesthetic management of special neonatal surgical emergencies
4.1. Congenital diaphragmatic hernia
CDH is one of the complex and compelling anomalies in the neonatal period. CDH occurs in
about 1:2400 and 1:3000 live births [8, 15]. Incomplete formation of the diaphragm and the
inability of the intestines to return to the abdominal cavity result in CDH. Posterolateral
foramen originated hernia (foramen of Bochdalek) constitutes 90% of the cases. In patients
with CDH because of the displacement of the abdominal contents until the mediastinum,
pulmonary hypoplasia (unilateral or bilateral) and possible mediastinal shift are serious
Anesthetic Management of Neonatal Emergency Abdominal Surgery
http://dx.doi.org/10.5772/63567197