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

A diagnosis of congenital heart disease (CHD) increases perioperative risk for children having surgical procedures. Some will require anaesthesia at a specialist cardiac centre, while for others it is safe and appropriate to have their procedure in a local district general hospital (DGH). Children with complex CHD and poor physiological status carry the highest risk of cardiac arrest and mortality. Clinical features of cardiomyopathy, cyanosis, pulmonary hypertension, arrhythmia and cardiac failure are most likely to require specialist input and tertiary referral, whereas those with a preoperative stay of less than 10 days undergoing elective, minor surgery, who are older than 2 years of age and physiologically well may be safely anaesthetized in a DGH. In order to maximize safety, the anaesthetist must carry out a thorough preoperative assessment, have an understanding of the patient's individual physiology and be prepared for the potential effects of general anaesthesia. Systemic vascular resistance is reduced by most induction agents and volatile anaesthetics, pulmonary vascular resistance is affected by changes in ventilation and gas exchange. The anaesthetist should be alert to particular potential complications, such as arrhythmias, hypoxia, bleeding and cardiac arrest.