Gert Poortmans1. 1. Department of Anaesthesiology, University Hospital Maastricht, Maastricht, the Netherlands. gpo@sane.azm.nl
Abstract
PURPOSE OF REVIEW: Anaesthesiologists are often asked to administer sedation and anaesthesia to infants and children with congenital heart disease undergoing diagnostic and interventional procedures. A number of issues are pertinent to a safe and effective provision of care for these patients. The anaesthetic should ensure haemodynamic stability, provide real-life circumstances to ensure diagnostic accuracy, should be easy and reliable to titrate in order to cope with rapidly changing loading conditions and intense but short-lived haemodynamic disturbances. The anaesthetic drugs should not interfere with electrophysiological processes in the cardiac conduction system, and above all anaesthetic recovery should be swift and devoid of side-effects. RECENT FINDINGS: In recent years, new agents have been introduced in the anaesthetic care of these patients. One has studied the haemodynamic and electrophysiological properties of agents such as remifentanil, desflurane, sevoflurane and propofol and their use in children with congenital heart disease. New and older drugs have been combined in balanced techniques to decrease the side-effects associated with monotherapy. Besides these anaesthetic concerns, the controversy about the presence of an anaesthesiologist versus a non-anaesthesiologist still continues. SUMMARY: The newer anaesthetic agents, such as desflurane, remifentanil, sevoflurane and propofol are an integral part of our armamentarium to care for children with congenital heart disease. The combination of these and older drugs allow us to provide anaesthetic care in an effective and efficient way.
PURPOSE OF REVIEW: Anaesthesiologists are often asked to administer sedation and anaesthesia to infants and children with congenital heart disease undergoing diagnostic and interventional procedures. A number of issues are pertinent to a safe and effective provision of care for these patients. The anaesthetic should ensure haemodynamic stability, provide real-life circumstances to ensure diagnostic accuracy, should be easy and reliable to titrate in order to cope with rapidly changing loading conditions and intense but short-lived haemodynamic disturbances. The anaesthetic drugs should not interfere with electrophysiological processes in the cardiac conduction system, and above all anaesthetic recovery should be swift and devoid of side-effects. RECENT FINDINGS: In recent years, new agents have been introduced in the anaesthetic care of these patients. One has studied the haemodynamic and electrophysiological properties of agents such as remifentanil, desflurane, sevoflurane and propofol and their use in children with congenital heart disease. New and older drugs have been combined in balanced techniques to decrease the side-effects associated with monotherapy. Besides these anaesthetic concerns, the controversy about the presence of an anaesthesiologist versus a non-anaesthesiologist still continues. SUMMARY: The newer anaesthetic agents, such as desflurane, remifentanil, sevoflurane and propofol are an integral part of our armamentarium to care for children with congenital heart disease. The combination of these and older drugs allow us to provide anaesthetic care in an effective and efficient way.