There is no simple recipe for anesthetic management of the patient with congenital heart disease, and many rational approaches can be used. Choices depend on a thorough assessment of the patient's condition, the type of surgical procedure to be performed, and postoperative goals (e.g., mechanical ventilation vs. extubation). Review of cardiac catheterization and echocardiographic data will provide information concerning shunts, valve function, pulmonary hypertension, and ventricular function. It is necessary to understand the anatomy and pathophysiology of the patient's cardiac lesion so shunt balance, ventricular function, and rhythm can be better maintained; maintain good oxygenation and ventilation; and be familiar with the cardiovascular effects of anesthetic drugs and avoid cardiovascular depressants. A balanced technique using more than one anesthetic can often ensure adequate anesthesia while minimizing side effects. Be careful!
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