Total Intravenous Anaesthesia in a 550-Gram Extremely Preterm Neonate Undergoing Surgery for Meconium Ileus

Anaesthetic management in extremely preterm neonates requires more than standard protocols and instead demands a highly individualised approach.The authors report the case of an extremely low birth weight (ELBW) male infant, born at 26 weeks and 4 days of gestation with a birth weight of 550 g, who developed signs of meconium ileus in his second week of life, necessitating an urgent laparotomy.Given his delicate health and the risk of cardiac complications from gas anaesthetics, anaesthesia was initiated and continued using a total intravenous anaesthesia (TIVA) method with fentanyl, ketamine, atracurium, and a carefully adjusted propofol infusion.Intraoperative management prioritised physiological stability, ensuring normothermia, euglycaemia, and adequate fluid balance, along with sufficient anaesthetic depth.The surgery proceeded uneventfully, and the infant remained haemodynamically stable throughout; he was successfully extubated on postoperative day 12 with no anaesthesia-related complications.This case underscores the importance of a meticulously planned, team-based, and individualised anaesthetic strategy in the care of ELBW neonates undergoing surgery.