Purpose of reviewHypercarbia in pediatric patients is an important component of intraoperative management. Despite marked advances in medicine and technology, it is uncertain what the physiological CO 2 range in neonates, infants and small children. This data is extrapolated from the adult population. We are going to review advantages and disadvantages of CO 2 measurement techniques, causes and systemic effects of hypercarbia. We are going to discuss how to approach management of intraoperative hypercarbia. Recent findingsAlthough physiological range in this patient population may not be fully understood, it is known that any rapid change from a child's baseline increases risks of complications. Any derangements in CO 2 are further compromised by hypoxia, hypotension, hypothermia, anemia, all of which may occur in a dynamic operating room environment.

Over the past decade, advancements in prenatal ultrasound and availability of fetal MRI have allowed for early diagnosis of congenital anomalies, and anesthetic and surgical developments have facilitated successful management and interventions of fetal anomalies. Fetal anomalies such as twin to twin transfusion syndrome, neural tube defects, and malformations impacting the fetal airway, cardiac, thoracic, abdominal, and urological systems affect the smallest and most vulnerable patient population. Minimally invasive, open, and ex-utero intrapartum procedures are three types of interventions available for the treatment of correctable fetal anomalies. These fetal procedures halt further progression of congenital anomalies early in fetal development and decrease fetal/neonatal morbidity and mortality.1 Open fetal surgical procedures are indicated for neural tube defect and congenial diaphragmatic hernia repair. These open surgical procedures improve fetal conditions, and impact postdelivery disability and fetal/neonatal death.2 Conditions in which the fetus’ airway may be compromised by a head or neck mass increase the newborn’s risk for respiratory and cardiovascular failure. In such situations, an ex utero intrapartum therapy (EXIT) procedure may be performed. During the EXIT procedure, the fetus remains dependent on placental oxygenation provided by the maternal circulation. Anesthetic choice for fetal surgery depends on maternal comorbidity, airway evaluation, type of fetal surgery, and surgical needs.

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