Progress in paediatric cardiac surgery, cardiology and intensive care has had two major consequences for anaesthesia. Firstly, surgery is performed increasingly early on increasingly complex heart diseases, which means that management of these children is extremely specialised, with procedures centralised in centres dedicated to this type of treatment. Secondly, survival rates among these children are rising, regardless of whether patients have undergone total correction or non-anatomical palliation. Consequently, it is not uncommon for them to be admitted subsequently for non-cardiac surgery. It is therefore important for all anaesthetists to understand the basic tenets of congenital heart diseases, even though complex cases need to be managed in centres staffed by specialists in this field.

Moreover, it is interesting to note that very few recommendations based on a high level of evidence exist for the management of children with congenital heart diseases in the operating theatre, and particularly for CPB and cerebral protection. Due to the variability of the pathologies and the rarity of cases, it is impossible to perform large-scale randomised studies, which could potentially form the basis of best practice rules. Consequently, routine practice is based mainly on expert consensus and experience at key centres. The techniques presented here therefore merely reflect what has proved effective in the authors’ practice.



© BETTEX D, BOEGLI Y, CHASSOT PG, June 2008, last update May 2018