**8. Anaesthesia for catheterization laboratory procedures**

Diagnostic and interventional cardiology plays a major in the management of congenital heart patients. General anaesthesia for these procedures is associated with low risk of morbidity and mortality23. Some of the challenges faced by anaesthesiologist in cath lab include

	- a. Always use shielding devices like gown, glasses and thyroid collar
	- b. Keep a distance from radiation source
	- c. Minimize exposure time
	- d. Different resident and consultant should rotate rather than assigning one person for cath procedures

Catheterization procedures should only be performed in centers where facilities for paediatric heart surgery are available. Catheterization procedures can be performed under local, monitored anaesthesia care (MAC) and general anaesthesia. There are several difficulties which make these procedures lengthy and complicated. Difficulties during procedure vary from intravenous access by anaesthesiologist to arterial and venous access by cardiologist. Necessary equipment for intubation and drugs for resuscitation should be available as cardiac arrest in these patients is not uncommon24 when sedation is given for the procedure.

Although cardiologists do give sedation for certain procedures but another person with ability to resuscitate the patient should be available in cath lab. Laryngeal mask airway (LMA) is well tolerated by most of the patients but those patients who can develop airway obstruction (Down's syndrome) during procedure should be intubated before the start of procedure. Intubation should also be done on those patients who need TEE. Anaesthesiologist has to be very careful during TEE manipulation. High doses of analgesia are not required and only local anaesthesia infiltration at access site is sufficient.
