What are the anesthetic considerations?
These cases are a medical and not a surgical emergency. Therefore, prior to the start of anesthesia, hypovolemia and electrolyte and acid–base derangements should be com-pletely corrected. Prior to induction, the stomach should be suctioned with a large bore (14Fr) orogastric tube to decrease the risk of regurgitation and aspiration. If a smaller sized orogastric or nasogastric tube is already present, it should be replaced.
Although inhalation induction has been described for these patients, most anesthesiologists would consider these patients as having a “full stomach” and would either do a rapid sequence induction with cricoid pressure or an awake intubation. Maintenance of anesthesia can be accomplished either by inhalation or a balanced technique. Muscle relaxants are not absolutely necessary. The use of opioids may not be necessary because the surgeon usually infiltrates the surgical wound with local anesthetic, which provides adequate analgesia postoperatively. Glucose infusion should be administered during the procedure to avoid hypoglycemia. Extubation should be done only when the infant is awake and protective airway reflexes are re-established.
Depending on the postconceptual age of the infant, apnea monitoring may be necessary postoperatively.