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Part 4. Managing Anesthesia Care
Section E. Specialty Areas of Anesthetic Practice
Chapter 52. Anesthesia for Surgical Treatment of Congenital Heart Disease: A Problem-Oriented Approach
James S. Harrington, MD, Avinash C. Shukla, MBBS, and Paul R. Hickey, MD
1. Congenital heart diseases that decrease cardiopulmonary reserve include intracardiac shunting, hypoxemia from inadequate pulmonary blood flow or intracardiac shunting, congestive failure from volume or pressure overload, vascular obstructive disease from excessive pulmonary blood flow, various kinds of stenoses, and occasional coronary ischemia.
2. Many of the determinants of shunting (its magnitude and direction) may change considerably during anesthesia and operative manipulations.
3. There are simple shunts, bidirectional shunts, and occasionally complex shunts. The key for anesthesia providers is understanding the effects of vasodilators, cardiac depressants, and surgical manipulation on these various shunts.
4. "Bubble discipline" is an important concept in dealing with anesthesia administration for patients with congenital heart disease.
5. Chronic hypoxia leads to polycythemia, which, in turn, leads to dramatic increases in blood viscosity.
6. The anesthesia provider should understand the hemodynamic consequences of pulmonary vascular hypertrophy, the end stage of which is the Eisenmenger syndrome.
7. Even though a child with congenital heart disease may not have frank failure, cardiac reserves may be dramatically decreased,..."
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