Introduction: The risk of apnea after surgery is significant in neonates regardless of anaesthetic agents used. A prospective randomized study done at our institute to explore the hypothesis “post-operative neonatal recovery is better with sevoflurane and caudal block with spontaneous ventilation compared to a technique with muscle relaxants.”

Aim: To study neonatal recovery after sevoflurane and caudal block with spontaneous ventilation in comparison with the addition of Muscle relaxants.

Materials and Methods: Study done in 100 term neonates, undergoing emergency colostomy were studied for a period of 2 years. Group I patients induced and intubated with sevoflurane maintained spontaneous ventilation. Group II patients induction and intubation by sevoflurane and atracurium. Caudal block given in both groups with 1.25ml/kg volume of bupivacaine. Blinded observers recorded emergence timings and monitored postoperative apnea for 12 hours.

Results: Statistically no significant difference in the vital parameters recorded intraoperatively and post-operatively between the 2 groups. Median value of EtCO2 was different with p value < 0.05. Median time to first movement, eye opening, tracheal extubation and first cry was less in group I (150, 150, 180, 210 seconds) than in group II (300, 330, 360 and 420 seconds). Post-operative incidence of apnea is lesser in group I (3/50) than group 2 (11/50), Chi-square static is 6.3529. p value is 0.012 (<0.05). No rescue airway interventions were required in both groups.

Conclusion: Post-operative apnoeic spells are less and neonates wake faster with sevoflurane and caudal block with spontaneous ventilation compared to muscle relaxant group with IPPV. Sevoflurane and caudal block with spontaneous ventilation is preferable to other techniques for newborn lower abdominal surgeries.