Longnecker's Anesthesiology > Part 2. Preparing for Anesthesia > Section B. Preoperative Evaluation of the Anesthesia Patient > Chapter 18. Preoperative Assessment of the Newborn Myron Yaster, MD, and Richard A. Elliott, MD

Key Points

"1. Except for extraordinary circumstances, all newborns require anesthesia for surgery.

2. Maternal factors associated with increased perinatal risk include hypertension, diabetes, prolonged rupture of membranes, drug abuse (tobacco, alcohol, opioids, amphetamines) and use (antipsychotics, antidepressants, anticonvulsants), collagen vascular disease, and maternal infection (prolonged rupture of membranes) or inflammation.

3. The younger the infant, the more fragile the neurologic, pulmonary, and gastrointestinal systems, and the more likely the severity of complications.

4. The presence of a congenital anomaly should always alert the anesthesiologist to the potential for others.

5. The presence of any midline defect is almost always associated with another defect.

6. The newborn is an obligate nose breather.

7. The narrowest part of the infant's airway is at the level of the cricoid ring and not the vocal cords.

8. Premature infants are at risk of developing postanesthesia apnea for weeks after birth (48–60 weeks postconception age) whenever a potent vapor or ketamine is used.

9. Arterial hypoxemia, hypercarbia, acidosis, hypothermia, or pain may reverse this transitional circulation and restore the fetal circulatory..."