Cardiac Anesthesia
Anesthesia for the patient with congenital heart disease (CHD) begins with a comprehensive preoperative evaluation to safely transition patients through different phases of the anesthetic. Anesthesiologists must optimize patient hemodynamics relative to the presence and degree of shunting, obstruction, and resistance of pulmonary and systemic vascular beds. This can be challenging given that all anesthetic agents have an impact on the cardiopulmonary system. Induction of anesthesia can be safely accomplished via intravenous or inhalation techniques. Prior to incision, airway management and vascular access must be reliable, secure, and accessible. Judicious fluid administration and use of vasoactive medications help maintain hemodynamic stability during incision, dissection, and preparation for cannulation. The anesthesiologist must anticipate the possibility of catastrophic hemodynamic collapse. Given the numerous perturbations of cardiopulmonary bypass (CPB), multiple methods are used to provide myocardial and neural protection. Separation from CPB occurs only after the patient is warm, ventilated, metabolically optimized, and maintaining a stable cardiac rhythm. Treatment of coagulation abnormalities associated with CPB must be individualized, and blood product administration is common. Transition of care from the operating room to the ICU can be particularly challenging in post-cardiac surgery patients who require the constant support of many life-sustaining devices.
