Neonatal anesthesia: what you need to know

Each year, millions of neonates and young infants worldwide undergo surgery requiring general anesthesia, highlighting the critical role of pediatric anesthesia in modern healthcare.¹

In the United States alone, approximately six million children, including 1.5 million infants, undergo surgical procedures under general anesthesia annually, with many requiring multiple procedures and anesthetics.^{2, 3, 4}

Neonates and infants are the most vulnerable patient population undergoing anesthesia:

• 81% risk of neurodevelopmental disorder5
• 72% mortality of cardiac arrest in neonates receiving anesthesia6

They need: 

• Specialized care environments and equipment
• Precise delivery of medications and ventilation
• Experienced clinicians

Almost 30% of all general anesthesia procedures are for children less than 15 years of age.⁷

• 93% of pediatric cases use general anesthesia
• 21% of all pediatric anesthetics are for diagnostic procedures, with 79% of anesthetics for surgery.⁸
• 40% of anesthesia cases require non-operating room anesthesia (NORA) due to the limited ability of young children to be still during radiologic procedures such as Interventional Radiology.

Anesthesia care requires meticulous precision and personalization, especially for neonates.

Neonates are from birth up to 28 days old. They:

• Are the highest risk pediatric population, due to underdeveloped organ systems, higher consumption of oxygen, immature 
 liver and kidney function, and more.
• Face increased perioperative complications and higher mortality. Have higher sensitivity to anesthesia medications, increased risk of postoperative apnea, greater susceptibility to hypothermia, and more.
• Require more complex airway, vascular, and procedural management. 

Infants are ages 
 1 month to 12 months

Lung-protective ventilation

Key strategies⁸ include:

• Optimal PEEP, preventing the collapsing of alveoli at end-exhalation
• Low and precise volume preventing over-distention and lung injury

Advancements in mechanical ventilation capabilities enable precise, adaptive delivery of lung-protective strategies tailored to the fragile physiology of neonates.

Precise Individualized Patient Care 

Advances in anesthesia now enable tailored care for neonates through precise mechanical ventilation and inhaled low-flow anesthetic delivery.

In neonates, precise and protective ventilation is critical to minimize the risks of lung injury and long-term complications. This challenge is particularly pronounced in extremely small neonates, where even minor deviations in tidal volume can have significant physiological consequences.⁹

Precise vaporization

In neonates and children, low-flow anesthesia must be precise, accurate, 
 and support cardiopulmonary stability. This requires vaporizers that can:^{10, 11}

• Deliver accurate concentrations of volatile anesthestics at fresh gas flows as low as <500 mL/min
• Maintain output consistency despiete changes in ambient temperature or carrier gas composition
• Respond quickly to changes in flow or concentration settings

Digital vaporizers are designed to support the requirements of neonatal and pediatric patients with digital controls. By combining agent monitoring with flow compensation, digital vaporizer solutions are designed to deliver accuracy even at very low flows. The ability to respond rapidly to setting adjustments helps clinicians maintain control in anesthetic delivery, aligning precision with the adaptability needed in diverse and dynamic care environments. 

To learn more about advanced digital vaporization, visit Aisys CS^2™

Non-Operating Room Anesthesia (NORA)

In recent years, there has been a substantial increase in pediatric NORA cases. ¹² This trend is likely to continue as technological advancements enable more non-invasive procedures to be performed outside the traditional OR setting on more medically complex patients. This requires anesthesiologists to be adaptable and resourceful, coordinating with proceduralists, nursing staff, technicians, and support personnel outside the immediate vicinity.

Team Coordination, Communication, and Preparation

Effective multidisciplinary team training is critical for improving outcomes in neonatal and infant anesthesia, including simulations, clear definition of OR roles and responsibilities, and emergency response preparedness.^{13, 14}

Optimizing anesthesia care for neonates and infants requires a deliberate focus on precision, personalization, and collaboration to address the unique challenges of this high-risk population.

By advancing care pathways through innovations in refining ventilation strategies tailored to these patients’ dynamic physiology, and precise vaporization along with prioritizing effective team collaboration, anesthesia teams can significantly improve outcomes for these vulnerable patients.

© 2025 GE HealthCare. 

GE is a trademark of General Electric Company used under trademark license. 

September 2025 | JB03199XU

Sources: 

1. Jonathan M. Tan, Optimizing Pediatric Anesthesia Care for Neonates and Infants."
2. Jin Hwan Lee et al., Neurodevelopmental Implications of the General Anesthesia in Neonate and Infants, Experimental Neurology 272 (October 2015): 50–60, https://doi.org/10.1016/j.expneurol.2015.03.028.
3. Jennifer A. Rabbitts et al., Epidemiology of Ambulatory Anesthesia for Children in the United States: 2006 and 1996, Anesthesia and Analgesia 111, no. 4 (October 2010): 1011–15, https://doi.org/10.1213/ANE.0b013e3181ee8479.
4. Keane Y. S. Tzong et al., Epidemiology of Pediatric Surgical Admissions in US Children: Data from the HCUP Kids Inpatient Database, Journal of Neurosurgical Anesthesiology 24, no. 4 (October 2012): 391–95, https://doi.org/10.1097/ANA.0b013e31826a0345.
5. Reighard C, Junaid S, Jackson WM, et al. Anesthetic Exposure During Childhood and Neurodevelopmental Outcomes: A Systematic Review and Meta analysis. JAMA Netw Open. 2022;5(6):e2217427. doi:10.1001/jamanetworkopen.2022.17427
6. Sanjay M. Bhananker et al., “Anesthesia-Related Cardiac Arrest in Children: Update from the Pediatric Perioperative Cardiac Arrest Registry, Anesthesia and Analgesia 105, no. 2 (August 2007): 344–50, https://doi.org/10.1213/01.ane.0000268712.00756.dd.
7. Devan Darby Bartels et al., Estimating Pediatric General Anesthesia Exposure: Quantifying Duration and Risk, Paediatric Anaesthesia 28, no. 6 (June 2018): 520–27, https://doi.org/10.1111/pan.13391.
8. Sur, A. et al. (2024) Volume targeted ventilation a Framework of Practice, https://www.neonatalnetwork.co.uk/nwnodn/wp content/uploads/2025/01/GL-ODN-24-VTV-framework.pdf. Available at: https://www.neonatalnetwork.co.uk/nwnodn/wp content/uploads/2025/01/GL-ODN-24-VTV-framework.pdf.
9. Sweet DG, Carnielli VP, Greisen G, Hallman M, Klebermass-Schrehof K, Ozek E, et al. European
10. Polania Gutierrez JJ, Rocuts KR. Anesthesia Vaporizers. [Updated 2023 Jan 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559321/
11. Glenski T, Narayanasamy S. Low Flow Anesthesia in Pediatric Patients. Society for Pediatric Anesthesia. https://pedsanesthesia.org/spa-one-pagers/low-flow-anesthesia in pediatric patients/
12. Charlotte Bell and Patricia M. Sequeira, Nonoperating Room Anesthesia for Children, Current Opinion in Anaesthesiology 18, no. 3 (June 2005): 271–76, https://doi.org/10.1097/01.aco.0000169234.06433.48.
13. Nadya Yousef, Romain Moreau, and Lamia Soghier, Simulation in Neonatal Care: Towards a Change in Traditional Training?, European Journal of Pediatrics 181, no. 4 (April 2022): 1429–36, https://doi.org/10.1007/s00431-022-04373-3.
14. Anna Clebone et al., “The Development and Implementation of Cognitive Aids for Critical Events in Pediatric Anesthesia: The Society for Pediatric Anesthesia Critical Events Checklists, Anesthesia and Analgesia 124, no. 3 (March 2017): 900–907, https://doi.org/10.1213/ANE.0000000000001746.