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

Children with congenital heart disease (CHD) are at increased risk of morbidity, perioperative cardiac arrest and 30-day mortality from major and minor surgical procedures compared to healthy children. Factors associated with greatest risk are the complexity of cardiac disease and the physiological status of the child. Therefore the anaesthetist must understand balanced and single ventricle circulations and be able to assess the effects of four major complications of CHD: cardiac failure, arrhythmias, pulmonary hypertension and cyanosis. Other risk factors include type of surgery, age, ASA physical status and length of preoperative hospital stay. Because of the diversity of CHD and the range of surgical procedures a generalized approach to anaesthesia is impossible. Preoperative assessment, induction and maintenance should all be individualized to the child and tailored to the type of surgery. Whether surgery occurs in the local hospital or tertiary cardiac centre depends on risk classification (high, intermediate and low). 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.