**5. Intraoperative considerations**

Presence of CHD in paediatric patients poses a great challenge for anaesthetist13 as morbidity and mortality is quite high. Incidence of cardiac arrest in these paediatric patients under anaesthesia is higher14 than non CHD patients and mainly due to pharmacological interaction and over dose5.

Intravenous line must be placed in all patients even for minor procedure. All intravenous tubings should be free of air bubble. Polycythaemic patient must be well hydrated before induction either by IV or orally.

Sevoflurane15 is preferred over halothane due to better haemodynamic stability in CHD patients. Most of the CHD patients tolerate inhalation induction with sevoflurane while patients with poor cardiac function, may not tolerate inhalation induction. Ionotropes should be continued if patient is on ionotropes.
