Anesthesia For Noncardiac Surgery In Children With Congenital Heart Disease

Medical and surgical advancements in the care and treatment of infants and children with congenital heart disease (CHD) have resulted in the survival of these patients into adulthood. Consequently, it is not uncommon for an anesthesiologist to anesthetize a patient with CHD who is undergoing a noncardiac operation. Such patients may require a surgical intervention before or after cardiac surgical repair. Even in patient with corrected CHD, significant residual problems (eq, arrhytmias, ventricular dysfunction, shunts, valvular stenosis, regurgitation, or pulmonary hypertension) may exist.

            Therefore, regardless of the surgical correction, whether the proposed operation is cardiac or noncardiac, the anesthetic management for children with CHD is the same. A full understanding of the anatomy and the physiology of the patient’s cardiac defect before proceeding to elective surgery is required. The evaluation should be performed far in advance to allow additional consultations if needed and for gathering information important to the care of the patient.

            Adequate preoperative planning may significant by reduce the perioperative risk for the patient with CHD who is undergoing noncardiac surgery. Early consultation with the cardiologist caring for a patient with CHD is always wise. Because noncardiac surgeons may have less appreciate of the delicate homeostatic balance of the child’s cardiac pathophysiology, it is particularly important during noncardiac surgery that the anesthesiologist who maintains the often fragile circulatory balance during surgery, surgical insults must be anticipated preoperatively. Familiarity with the child’s pathophysology, preoperative preparation, choice of monitors, induction, maintenance, emergence from anesthesia, and plans for the postoperative period should avoid major problems in anesthesic management. ( Laurentius Dermawan,Cindy E. Boom)