What effects do anesthetic agents have on shunting in patients with cyanotic congenital heart disease

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Anesthetics can affect myocardial contractility, SVR, and PVR, and shunting can be influenced by any of these. Although it has been postulated that halothane or isoflurane may cause hypercyanotic spells by decreasing SVR, studies have demonstrated that right-to-left shunting usually does not change significantly as long as ventilation and oxygenation are maintained. Nevertheless, as with any patient with cardiovascular disease, it is wise to avoid great changes in hemodynamic parameters by careful dosing, combining anesthetic drugs to achieve a balanced technique, and using muscle relaxants to facilitate lower anesthetic doses.

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