Dexmedetomidine, high-flow nasal oxygen and regional anaesthesia for neonatal hand surgery.

We report the use of dexmedetomidine sedation, high-flow nasal oxygen and regional anaesthesia for a term neonate (16 days old, 2.6 kg) with amniotic band syndrome undergoing hand surgery. We discuss the pharmacokinetics of dexmedetomidine and use of high-flow nasal oxygen insufflation in this age group. Age-dependent pharmacokinetics and pharmacodynamic effects of dexmedetomidine make dosing challenging in neonates, but when used appropriately it can minimise the need for exposure to general anaesthesia, airway instrumentation and mechanical ventilation, all of which are associated with adverse perioperative events in neonates, such as apnoea, bradycardia and prolonged postoperative ventilation.