Anaesthetic management of children with congenital heart disease for non-cardiac surgery

Abstract

Congenital heart disease (CHD) is the most common birth defect, occurring in approximately one in 125 live births.¹ Advances in medical care have led to ∼90% of these children surviving to adulthood.² Children with CHD are subject to the same childhood illnesses as healthy children and therefore present to their local hospital requiring both elective and emergency surgery. In general, children with CHD undergoing non-cardiac surgery have an increased risk of morbidity, perioperative cardiac arrest, and a higher 30 day mortality.^3–6 However, the complexity of cardiac defects and the variety of non-cardiac surgery make it impossible to generalize. A 9-yr-old child with a repaired atrial septal defect (ASD) who requires an emergency appendicectomy presents minimal risk; yet, a 12-yr -old with a failing single-ventricle circulation for the same operation presents a significant challenge even to the most experienced paediatric cardiac anaesthetist.