Anesthetic Considerations in Congenital Heart Disease
The approach to anesthesia in the child with congenital heart disease (CHD) is the same whether the heart has been reconstructed or the congenital heart disease has not been surgically treated. In both cases, the current clinical status of the child’s cardiac pathophysiology must be understood. When anesthesia is being given for noncardiac surgery, cardiopulmonary bypass is not available for support if surgical and anesthetic intrusions overwhelm circulatory homeostasis. During noncardiac surgical procedures, surgeons unfamiliar with the physiologic limitations imposed by congenital heart disease may place substantial burdens on the circulation in the course of their procedures. Since the anesthesiologist must maintain the often fragile circulatory balance in spite of surgical trespass, destabilizing surgical insults must be anticipated in the anesthetic plan. Familiarity with the child’s pathophysiology, the details of any reparative cardiac surgery, and the planned noncardiac operative procedure should avoid major problems in anesthetic management. Evaluation, preoperative preparation, choice of monitoring, induction, maintenance, emergence, and plans for postoperative care all are predicated on this familiarity.
KeywordsCongenital Heart Disease Ventricular Septal Defect Pulmonary Blood Flow Noncardiac Surgery Fontan Procedure
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