Neonates presenting for specialist neonatal and paediatric surgery range in age and complexity from the extremely premature infant undergoing laparotomy for necrotising enterocolitis to the healthy term neonate undergoing hernia repair. Many patients presenting for repair of congenital abnormalities are born prematurely and/or have congenital cardiac defects, which leads to additional challenges. The most common general surgical conditions presenting in the newborn period are oesophageal atresia (OA) with or without trachea-oesophageal fistula (TOF), congenital diaphragmatic hernia (CDH), intestinal atresias, meconium ileus, malrotation and volvulus, Hirschsprung’s disease, imperforate anus, exomphalos, gastroschisis and necrotising enterocolitis (NEC). Anaesthetic techniques should be tailored to the relevant surgical condition, but most of the key principles of management are similar and require an in-depth knowledge of the anatomical, physiological and pharmacological differences particular to this vulnerable group of patients. In this chapter, we discuss the general considerations for anaesthesia in neonatal surgery and then each specific neonatal condition in relation to their anaesthetic and surgical management.