Anesthesia for Premature Infants and Micropremies

Advances in medicine has led to the increased survival of micropremies and premature infants. The anesthetic management for these patients has unique considerations and should only be provided by experts at specialized pediatric centers. Technical procedures and monitoring can be challenging due to their small size. Related to the physiology and immaturity of the airway, respiratory, cardiac and neurologic systems, there is an increased perioperative risk that may be related to hypoxemia and apnea and rapid desaturation, reversal of intracardiac shunts, and intraventricular hemorrhage. Immature renal and hepatic systems are related to decreased drug metabolism and demand careful and accurate administration of medications. The patients are prone to hypothermia and hypoglycemia. In addition, there may be congenital anomalies, syndromes, or other metabolic issues that may not have been fully worked up at the time of presentation for anesthesia. Emerging information related to potential neurotoxicity related to exposure to anesthetic agents has led to continual research and understanding of these mechanisms in order to provide the safest care. A meticulous approach, careful planning, and collaborative approach with the multidisciplinary neonatal team are essential to ensure the best possible outcome for this unique patient population.  This review contains 3 figures, 4 tables, and 36 references. Keywords: inguinal hernia repair, micropremies, prematurity, neonatal anesthesia, neurotoxicity, neonatal intensive care, necrotizing enterocolitis, preterm infants