Abstract

Introduction: Congenital heart disease (CHD) pose unique challenges for anaesthetic management. These children may have impaired cardiac output, altered pulmonary dynamics and a variety of comorbidities that require careful preoperative evaluation and perioperative management. Case Report: A 4 year old boy diagnosed with Left encysted hydrocoele of cord was posted for Left sided Herniotomy. He is a known case of Atrial Septal Defect (ASD), Patient did not have any history of previous surgeries or any NICU/PICU admissions. Pre-operative systemic examination and airway examination were normal, 2d echo was done which showed situs solitus levocardia, 25mm large ASD with left to right shunt. dilated RA & RV. grade 1 TR with mild PAH, mild PR, noPS. LVEF 60%. Cardiac opinion was taken and can be taken up for surgery under moderate risk. Intraoperatively patient was induced with Inj. glycopyrolate, Inj. midazolam, Inj.Propofol and Inj.Atracurium. Patient was intubated and maintained with Isoflurane, O2 & N2O; monitoring of SBP, RR, NIBP, SPO2 were done. Post-operative vitals were stable. Pt was extubated and shifted to PACU for observation. Conclusion: Anaesthetic management of children with congenital heart disease undergoing non-cardiac surgery is complex and requires a team approach, involving paediatric anaesthesiologists, cardiologists, and surgeons. Detailed preoperative assessment, individualized anaesthetic techniques, and careful intraand postoperative management are critical to minimizing risk and optimizing outcomes in these vulnerable patients. Key Messages: Congenital heart disease with major defects can present with cardiac failure and difficult to thrive. When they present for surgery, the risk associated with anaesthesia and stress of surgery can lead on to major complications. Meticulous planning, multidisciplinary approach is necessary for a better outcome.

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