Analgesia, sedation, and
anesthesia are a continuum. Diagnostic and/or therapeutic procedures in newborns often require
analgesia, sedation, and/or
anesthesia. Newborns, in general, and, particularly, those with
heart disease, have an increased risk of serious adverse events, including mortality under
anesthesia. In this section, we discuss the assessment and management of
pain and discomfort during interventions, review the doses and side effects of commonly used medications, and provide recommendations for their use in newborns with
heart disease. For procedures requiring deeper levels of sedation and
anesthesia, airway and hemodynamic support might be necessary. Although associations of long-term deleterious neurocognitive effects of
anesthetic agents have received considerable attention in both scientific and lay press, causality is not established. Nonetheless, an early multimodal, multidisciplinary approach is beneficial for safe management before, during, and after interventional procedures and surgery to avoid problems of tolerance and
delirium, which can contribute to long-term
cognitive dysfunction.