Patients with congenital heart diseases (CHDs) are at increased risk of developing complications during anaesthesia. Improvements in medical and surgical management in recent decades have resulted in significantly more children with CHD surviving to adulthood. The aim of this article is to focus on broad classification of CHD and to provide an updated review on the current perioperative anaesthetic management of CHD patients in different settings such as (a) interventional cardiac procedures that have dominated the field, (b) uncorrected patients for non-cardiac surgery and (c) corrected patients for non-cardiac surgery. The complexity of the defects along with a variety of non-cardiac surgery makes it impossible to have one single-anaesthesia technique. Search on Ovid, PubMed, Google Scholar and Medline were done with MeSH terms such as ‘congenital heart disease’, ‘cardiac catheterisation’, ‘anaesthetic management’ and ‘non-cardiac surgery’ mainly focusing on review articles and controlled studies for preparing the article.

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Peripheral nerve blocks (PNB) are getting significant recognition for intraoperative and publish operative pain control because of their distinct advantage over general anaesthesia anesthesia. There are different ways to a brachial plexus block. The coracoid infraclavicular approach is feasible in almost all patients. A prospective randomized control trial was performed to compare the clinical effect of infraclavicular and supraclavicular brachial plexus block using a nerve stimulator for upper limb surgery. Sixty patients receiving upper limb orthopedic surgery under infraclavicular or supraclavicular brachial plexus block were enrolled in this study. The supraclavicular brachial plexus block was performed using nerve locater and ultrasound technique with 40 ml of 0.5% bupivacaine 1.5 mg/kg, ligocaine 2% with adrenaline 4mg/kg and distilled water. This study observed which nerve types were stimulated, and scored the sensory and motor blockage. The quality of the block was assessed intra-operatively and postoperatively with modified Lovette rating scale and McGill's pain score. The duration of the sensory, motor block and the complications were assessed. The patient's satisfaction with the anesthetic technique was assessed after surgery. Conclusions: In our study we observed similar effect in both infraclavicular and supraclavicular brachial plexus block. The infraclavicular approach may be preferred to the supraclavicular approach as complications are fewer with infraclavicular approach but expertise is needed in infraclavicular block.

Incidence of awareness in patients undergoing cardiac surgery is up to 23% compared to its incidence of 1% during general surgery. In our institute we conducted study in 40 patients undergoing valve surgeries and compared volatile agent vs. conventional method with help of BIS monitoring. Partly because of the difficulty of administering volatile agents during cardiopulmonary bypass (CPB), total intravenous anaesthesia (TIVA) has been a popular technique used by cardiac anaesthetists in the last few decades. However, the possibility that volatile agents cut back mortality and the incidence of myocardial infarction by preconditioning the myocardium has stimulated a revival of interest in their use for cardiac anaesthesia. We observed the higher BIS values were seen in conventional group with requirement of higher dose of propofol as a rescue to avoid intraoperative awareness. The haemodynamics were steadily maintained in isoflurane group. The inotrope score was less in isoflurane group indicating myocardial protective effect of isoflurane. In conclusion, in patients undergoing heart surgery with CPB, the findings of this study indicate that appropriate use of isoflurane to maintained depth of anaesthesia during CPB should be monitored with use of BIS and ETAC.

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