After securing the airway and verifying bilateral breath sounds, opioid titration with fentanyl should be given in repeated doses. This neonate might be sensitive to any anesthetic agent because of their cardiovascular anomalies; therefore, titrating fentanyl to arterial blood pressure via the arterial line decreases the chance of inadvertent drops in perfusion. Because the neonate is not going to be extubated, fentanyl can be dosed safely at 50 µg/kg or higher to allow for dense analgesia. Neuromuscular blocking agents such as rocuronium and cisatracurium can be given and redosed at regular intervals to facilitate surgical dissection. If tolerated, small concentrations of 0.5% to 4% desflurane or sevoflurane 0.25% to 1.5% can be administered to synergize with the opioid. The prostaglandin infusion should be maintained throughout the surgery.