Neonate

The smallest child I've anesthetized so far was a three week old premature infant who was about three kilos (6.6 lbs). Prematurity, unfortunately, is associated with a lot of medical problems, and this infant in the neonatal intensive care unit needed an abdominal surgery. She was tiny. It was amazing and a little terrifying to hold this baby and carry her onto our warmed bed. She seemed so incredibly fragile, and our EKG leads looked enormous on her chest. In another time and place, I might have found our neonatal equipment - the breathing tube, the blood pressure cuff, the oral airway - cute because they were so small, but now I found the task daunting. All my medications were double diluted or drawn in TB syringes because the doses were so small.

Suddenly things that were irrelevant for larger children or adults became important. I had to debubble my IV tubing. I turned up the room temperature. I learned the appropriate rate and squeeze to mask ventilate the infant. After inducing anesthesia, I had to intubate quickly and realized the airway anatomy was tiny; there was barely a millimeter of space where I could lift up the epiglottis and see the vocal cords. If my hand shook the smallest amount, the epiglottis flopped down and I lost my view. Luckily, everything went quite smoothly, and I managed to keep my youngest child alive during one of the first surgeries of her life.

Image of a healthy newborn about the size as the baby described above shown under GNU Free Documentation License, from Wikipedia.