Anesthesia for Cardiac Surgery in Neonates

Abstract

Cardiac surgery in the neonate usually is indicated for treatment of congenital malformations of the heart or cardiovascular system. Extremely rare is the need for surgical intervention for pathologies such as endocarditis, cardiac tumors, rhythm disturbances, or pericardial disease. Thus, the focus of this chapter is on anesthesia for cardiac surgery in the neonate with congenital heart disease (CHD). This chapter begins with a brief overview of the cardiovascular physiology of the fetus and neonate, followed by a discussion of CHD that includes the epidemiology, clinical features, and diagnosis in the neonate. Selected anomalies of particular relevance in this age group are reviewed, with emphasis on anatomic features, pathophysiology of the defect, perioperative management, and specific considerations during anesthetic care. This is followed with an in-depth discussion on the important aspects of anesthetic practice in the neonate with CHD undergoing cardiac surgery. Finally, several specific perioperative problems and concerns in the neonate are highlighted.