Prevention and management of hypoxemia during anesthesia induction in the neonate and small infant

Hypoxemia and related complications are the leading adverse events during an anesthetic in neonates and infants younger than 60 weeks postconceptual age. This risk is more prominent during induction of anesthesia. A preoperative assessment and plan should be made for both management of an uncomplicated anesthesia induction and the unexpectedly difficult airway. Developmental anatomy and physiology contribute to a higher incidence of unexpected difficult bag mask ventilation, intubation, and cannot intubate, cannot oxygenate situations. This has driven the advancement of oxygen delivery methods, size-specific airway equipment, and comprehensive pediatric-based difficult airway algorithms and cognitive aids. Recommendations for the future include increased education, training, and standardization of care. A specialized clinical approach to efficiently secure the infant airway and mitigate rapid onset of hypoxemia is key. Limitations to our study results include cost of equipment and implementation, but quality and strength of supporting evidence is robust.