Pediatric anesthesia in patients with congenital heart disease

Pediatric patients with congenital heart disease (CHD) present significant anesthetic challenges due to complex cardiovascular physiology and increased perioperative risk. Given the growing survival of this population and the consequent need for cardiac and non-cardiac procedures, this study aimed to analyze current anesthetic approaches and perioperative management strategies in pediatric CHD patients. An integrative literature review was conducted using PubMed, MEDLINE, SciELO, and the Cochrane Library, including studies published between 2021 and 2025. Controlled descriptors were identified through DeCS and MeSH, and articles were selected following predefined inclusion and exclusion criteria. The reviewed evidence highlights the importance of lesion-specific risk stratification, individualized anesthetic planning, advanced hemodynamic monitoring, and multimodal analgesic strategies. Children with complex or cyanotic defects were found to be at higher risk for intraoperative instability and postoperative complications, particularly during non-cardiac procedures. The findings also emphasize the relevance of multidisciplinary coordination and physiology-driven management to optimize safety. In conclusion, pediatric anesthesia in patients with CHD requires a comprehensive and individualized perioperative approach, supported by current evidence, to reduce complications and improve clinical outcomes.