No abstract

What is Known and Objective Opioids are commonly administered to infants having surgery. Opioid induced hyperalgesia (OIH) is a known adverse effect of opioids in adults but can be difficult to identify in infants. Case Summary A 3‐month‐old received high‐dose fentanyl during anorectoplasty for imperforate anus. He had signs and symptoms of OIH immediately after surgery. His pain and agitation were difficult to manage but improved after he received ketamine. What is New and Conclusion OIH should be considered in infants postoperatively when pain worsens despite administration of escalating doses of opioids. Ketamine can be an effective therapeutic for OIH.

A 4‐day‐old, 3.3 kg infant presented with suspected intestinal malrotation, necessitating emergent diagnostic laparoscopy. Intra‐operatively, the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) came back positive. This is the first case report of emergency surgery and anesthesia in a positive SARS‐CoV‐2 newborn. This report highlights a neonate with an incidental positive SARS‐CoV‐2 test, no known exposure history, negative polymerase chain reaction maternal testing, and absence of respiratory symptoms who required modified pressure control ventilation settings to adequately ventilate with the high‐efficiency particulate air filter in situ.