ANESTHESIA MANAGEMENT FOR CONGENITAL HEART DISEASE

Abstract

The anesthetic management of pediatric patients with congenital heart disease (CHD) requires a thorough understanding of the patient's unique anatomical variations, the planned surgical intervention, and associated physiological changes. CHD is broadly categorized as either cyanotic or a cyanotic. Cyanotic CHD results from the admixture of oxygenated and deoxygenated blood within the systemic circulation. Examples of cyanotic CHD include Tetralogy of Fallot, Double Outlet Right Ventricle (DORV), Total Anomalous Pulmonary Venous Return (TAPVR), Tricuspid Atresia, Critical Pulmonary Stenosis, Pulmonary Atresia, and Hypoplastic Left Heart Syndrome. A cyanotic CHD encompasses conditions such as Atrial Septal Defect, Ventricular Septal Defect, and Patent Ductus Arteriosus.

Pre-anesthetic evaluation is essential for determining the patient's pre-operative physical status, assessing the specific congenital anomaly, and evaluating the severity of the cardiac defect. This information allows for meticulous perioperative planning. Intraoperative management must consider the dynamics of shunt flow in CHD, which depends upon the shunt's anatomical characteristics, specifically its size and configuration.

While inhalational agents are frequently employed for induction and maintenance of anesthesia in pediatric cardiac cases, patients exhibiting compromised ventricular function or dependence on systemic vascular resistance (SVR) and/or pulmonary vascular resistance (PVR) necessitate pre-induction intravenous access. In these patients, anesthetic agents that could further impair hemodynamic stability should be avoided or used judiciously. Post-induction anesthetic choices are guided by ventricular function (including the presence or absence of congestive heart failure), the anticipated need for cardiopulmonary bypass, and the probability of requiring mechanical ventilation or tracheal extubating post-operatively.