Over the past 80 years or so, provision of anesthesia for the neonate requiring surgery has developed from being a relatively haphazard affair to achieving the status of a recognized subspecialty. The improved survival rates seen following surgery, where even the smallest and sickest infants are concerned, have been due in no small part to advances in anesthetic management. Equally important has been an increased appreciation of the need for an efficient smooth-working team. The success of neonatal surgery depends on maximum cooperation between surgeon, anesthetist, neonatologist, and nursing and paramedical personnel. It is appropriate, therefore, that everyone involved in the care of neonates, whether working inside or outside the operating theater, should be familiar with the basic techniques used in maintaining a favorable physiologic milieu in the face of surgical intrusion, while at the same time ensuring adequate anesthesia. This chapter will consider the preoperative evaluation and preparation of the surgical neonate, anesthetic equipment, choice of anesthetic agent and technique (with reference to the pharmacology of the newborn), induction of anesthesia and endotracheal intubation, maintenance and reversal of anesthesia, perioperative monitoring and fluid therapy, the anesthetic implications of congenital anomalies, and finally, specific considerations for the premature infant undergoing surgery.