Thoracoabdominal and General Surgery

Provision of anesthesia for thoracoabdominal surgery in the neonate presents a number of specific challenges to the anesthesiologist. Many neonates are born at term in good condition, with or without an antenatal diagnosis, but many others are born premature and/or of low birth weight with associated cardiac abnormalities, pulmonary hypertension, and/or complications relating to the specific surgical diagnosis. Many of the principles of neonatal surgery are discussed elsewhere—this chapter considers specific conditions that require thoracic or abdominal surgery in the neonatal period, and the anesthetic and surgical requirements for each. There are very few randomized controlled trials to guide management. Most management strategies are based on retrospective case reviews or expert opinion. The use of minimally invasive techniques is becoming increasingly common and these approaches are also discussed.