1)     RECOMMENDATIONS

a)      General Approach

i)        Patients under 12 weeks of age are consider at higher risk during anesthetic events

ii)       They possess little cardiac reserve

(1)   These patients are much more dependent on heart rate for cardiac output

iii)     They have an increased oxygen requirement and very small airways making for an increased overall risk of hypoxia

iv)     They are more prone to hypothermia

v)      They generally require lower doses of sedatives, tranquilizers, and injectable anesthetics

(1)   Renal and hepatic functions are not yet mature and will delay drug clearance

vi)   The use of NSAIDs in patients under 12 weeks is generally discouraged  

vi)     They are prone to hypoglycemia

(1)   Withholding food for only 4 hours prior to anesthesia helps to minimize this concern

(1)   Offering food within 2 or 3 hours of recovery is also recommended

b)      Pre-anesthetic Medications

i)        Opioids combined with benzodiazepines are effective preanesthetic agents

(1)   Anticholinergics are recommended to help maintain adequate heart rate and cardiac output

(a)    Glycopyrrolate would be preferred over atropine

ii)       Acepromazine and alpha-2 agonists like medetomidine and xylazine should be avoided

c)      Induction

i)        Preoxygenate whenever possible

ii)       Standard induction agents can be used if venous access is available

(1)   Give carefully to effect expecting to need a lower total amount per kg

(2)   Propofol is a good choice when given carefully to effect

iii)     Masking may be necessary when there is no direct venous access

(1)   Intubation is highly recommended whenever possible

d)      Maintenance

i)        Isoflurane or sevoflurane

ii)       Nonrebreathing systems are recommended for neonatal patients

e)      Support

i)        Fluid support is important

(1)   Neonates are moire sensitive to fluid overload

(a)    Basic fluid rates from 5 to 10 ml/kg/hr are usually sufficient

(2)   If a standard IV catheter is not an option, intraosseous fluids are an effective next choice

(a)    Fluids contain 2.5 % or 5.0 % dextrose may be necessary for these patients

ii)       Monitor body temperature – provide safe supplemental heat

2)     PRECAUTIONS

a)      Pre-anesthetic Medications

i)        Acepromazine, xylazine, and medetomidine are not recommended

ii)       Keep the doses of all agents on the low end of the dose range

b)      Induction

i)        Give carefully to effect

c)      Maintenance

i)        A circle system is not recommended

d)      Support

i)        Do not use microwaved rice bags – their use has been associated with major third degree patient burns