This document discusses anesthesia considerations for neonates and infants under 1 year of age undergoing surgery. It covers age-specific anatomical and physiological differences, preoperative evaluation and preparation, induction and maintenance techniques, monitoring, fluid management, temperature control, and postoperative care. Special conditions like congenital anomalies requiring surgery are also reviewed.

1. Anesthesia During the First Year of Life Hany El-Zahaby, MD Dept. of Anesthesia, Ain Shams University

4. Age-specific considerations Airway differences –Infant Vs Adult Big head , small body Tongue/Epiglottis relatively larger Glottis more superior, at level of C3 (vs C4 or 5) Cricoid ring narrower than vocal cord aperture

17. Assessment of dehydration Severe (150ml/kg) Moderate (100ml/kg) Mild (50ml/kg) 15 ++irrit/lethargic Intense Parched Absent Sunken Increased <0.5ml/kg/hr 10 Irritable Moderate Dry + + + <1ml/kg/hr 5 Normal Slight Normal Normal Flat Normal <2ml/kg/hr Wt loss% Behavior Thirst Mucous memb. Tears Anterior fontanel Skin turgor Urine output

19. Prevention of Heat Loss Radiation Evaporation Conduction Convection

27. Choanal atresia OGT CHARGE Syndrome (Coloboma-Heart –Atresia-Retarded-Genital-Ear)

28. Laryngomalacia

34. Thoracic Surgeries Esophageal Atresia/TEF 1cm

35. Thoracic Surgeries Esophageal Atresia/TEF 1:3000 M:F 25:3 First fed chocking, cyanosis CHD, VACTERL association 13%

40. Abdominal Surgeries Congenital Diaphragmatic Hernia 1:5000 M:F 1:1.8 Resp. distress Scaphoid abdomen Shifted heart sounds Bil. Pulmonary hypoplasia Hypoxia, hypercarbia Pulmonary HTN, shunting

43. Omphlocele 1:5000 Hernial sac CHD 30-40% Blood loss Hypothermia High abdominal pressure RSI Insensible water loss 10ml/kg/h UOP > 30 mmHg (Ventilation )

44. Gastroschisis Midline above umbilicus Other abnormalities are rare No hernial sac Coverage Heating I.V fluids Abdominal pressure