Indications for cardiac anesthesia in children

Children with congenital and acquired heart disease are at high risk for developing anesthesia-related cardiac arrest. Children with single ventricle physiology, left ventricular outflow tract obstruction, including Williams syndrome, cardiomyopathy, and pulmonary hypertension are at the highest risk for developing anesthesia-related cardiac arrest. The purpose of this article is to review anesthesia in children with cardiovascular diseases, factors associated with anesthesia-related cardiac arrest, and treatment to decrease anesthesia-related mortality. Children with congenital heart disease have fewer complications and lower mortality when the anesthesiologist has specialized training and experience in pediatric cardiac anesthesia. Comprehensive evaluation before anesthesia includes a review of the patient, planned procedure, risks, and interventions for risk reduction. Admission for initiation of intravenous fluids at the start of fasting may be advised, potentially preventing risks associated with decreased preload from fasting. The anesthetic plan includes selection of agents and monitoring for induction, maintenance, emergence, and postanesthesia care. Patients with single ventricle physiology may require adjustments of pulmonary and systemic vascular resistance to optimize pulmonary and systemic blood flow. Left ventricular outflow tract obstruction may be subvalvular, valvular, or supravalvular, static or dynamic, and associated with an increased risk of perioperative cardiac events, including arrhythmias, myocardial ischemia, and heart failure. Patients with Williams syndrome may have supravalvular aortic stenosis, pulmonary artery stenosis, biventricular outflow tract disease, or coronary artery abnormalities; anesthesia typically includes intravenous induction and strategies to minimize blood pressure variation and tachycardia. In patients with pulmonary hypertension crisis under anesthesia, prompt treatment includes mild hyperventilation with 100 % oxygen and initiation of nitric oxide. Multidisciplinary collaboration between specialists, including anesthesiologists, cardiologists, surgeons, radiologists, and interventional specialists, may facilitate the development of the safest possible anesthetic plans. • Children with cardiac disease may require specialized anesthesia care. • Anesthesia-related cardiac arrest occurs most commonly during noncardiac surgery. • Cardiac anesthesia is safest when potential complications are anticipated. • Preanesthesia planning includes ensuring the availability of specialized resources.