Anästhesie bei Kindern mit angeborenen Herzfehlern

Abstract: Congenital heart disease (CHD) is the most common congenital malformation, affecting approximately 1 in 100 newborns. Due to advances in clinical management of CHD, the population of patients with congenital heart disease is growing. Gaining knowledge and expertise in the perioperative management of patients with CHD is hence becoming increasingly important not only for specialized, but for all anesthetists.The perioperative management of patients with CHD varies depending on the anatomy and pathophysiology of the specific defect and the planned intervention. A pathophysiological classification of CHD differentiates between lesions with shunts, as well as obstructive, regurgitant and mixing lesions. Perioperative planning should be interdisciplinary and extend from careful preoperative assessment through an individualized anesthesia plan and postoperative care.Anticipation of hemodynamic changes induced by anesthesia is essential to choose the optimal anesthesia technique, the optimal drugs, as well as the optimal ventilation and backup strategies. Performing smaller procedures under sedation with or without local or regional anesthesia and while maintaining spontaneous breathing can be advantageous.During general anesthesia measures to control and adjust pulmonary vascular resistance and systemic vascular resistance, including the careful adjustment of ventilation parameters, as well as the management of fluid status, is crucial for a good outcome. This article provides an overview of common CHD lesions and general principles relevant to anesthesia for children with CHD.