Anaesthetic implications of congenital heart disease for children undergoing non-cardiac surgery

Children with congenital heart disease (CHD) are at increased risk of cardiac arrest and 30-day mortality from major and minor surgical procedures compared with healthy children. Therefore, a prerequisite for anaesthetizing these children is a thorough knowledge of the specific cardiac anatomy, cardiorespiratory physiology and the potential risk of complications for each individual case. Anaesthetists must be familiar with not only the normal, series cardiac circulation but also the parallel (or balanced) and single-ventricle circulations. Anaesthetists must also understand the complex interaction between systemic and pulmonary vascular resistance and the many factors that influence these variables, and be aware of the four major complications associated with CHD and know which children are most at risk. Induction and maintenance of anaesthesia should be individualized to the child and tailored to the type of surgery. Whether surgery occurs in the local hospital or tertiary cardiac centre is a matter for debate. Some children require full cardiac anaesthesia, intensive care and cardiology support, making care in the local hospital inappropriate, whereas, for others, care in their local hospital is both safe and convenient.