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Left‐to‐right shunt lesions are common among congenital heart defects and present in a variety of forms. This chapter summarizes the general concepts and pathophysiology that these lesions share, and details the incidence, anatomy, natural history, pathophysiology, surgical and transcatheter approaches and outcomes, and anesthetic considerations for each of eight left‐to‐right shunt lesions. These...
Pulmonary hypertension (PH) is a multifactorial disease requiring thorough evaluation and classification followed by focused therapy. Several factors associated with the perioperative period are potential triggers for a pulmonary hypertensive crisis, and patients with PH have significant risks of cardiac arrest or death. Safe and successful anesthetic management of these patients requires understanding...
With a growing population of children, adolescents and adults with congenital heart disease of all types and severities, the number of these patients presenting for noncardiac surgery and imaging procedures will also increase. Pediatric patients on ventricular assist device support or with pacemakers and/or defibrilllators requiring anesthetic care are no longer rare. A combination of proper planning...
Over the last 70 years, pediatric cardiac anesthesia has developed as a subspecialty of pediatric anesthesia. Advancement in surgical treatment of CHD started with simple surgical ligation of a patent ductus arteriosus (PDA) and evolved to sophisticated, staged repair of complex intracardiac lesions in low‐birth‐weight neonates requiring cardiopulmonary bypass (CPB) and circulatory arrest to the most...
This chapter reviews the cardiovascular effects of commonly used anesthetic and sedative agents, focusing wherever possible on human studies in infants and children with congenital heart disease. Volatile agents are discussed first, followed by nitrous oxide, and then opioids and benzodiazepines. Next, intravenous agents propofol, ketamine, etomidate, and dexmedetomidine are presented. Special conditions...
Hemodynamic assessment and treatment via invasive access of the circulation is essential in the anesthetic management of patients undergoing surgery for congenital heart disease. This chapter will review techniques for vascular access in children, emphasizing ultrasound‐guided techniques to guide successful placement, interpretation of data obtained from invasive monitoring, and strategies for avoiding...
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