**7.1 PH in children**

PH in children is associated with significant perioperative risk for major complications, including pulmonary hypertensive crisis and cardiac arrest (Friesen & Williams, 2008).

The goals of balanced and cautious anesthetic management are to provide adequate anesthesia and analgesia for the surgical procedure while minimizing increases in PVR and depression of myocardial function.

The development of the aforementioned specific pulmonary vasodilators has led to significant advances in the medical therapy of PH that can be incorporated in the anesthetic management of the pediatric population.

The incidence of complications in children with PH undergoing cardiac catheterization was found to be independent of the method of airway management. Tracheal intubation has been reported to precipitate pulmonary hypertensive crisis and death in critically ill pediatric patients with severe PH, so many anesthesiologists avoid intubation. Similarly, deep extubation can decrease exposure to noxious airway stimulation following selected procedures.

However, similarly to adult patients, PVR can be affected by many other aspects of anesthesia technique such as the inspired oxygen concentration, acid-base management, ventilation mode, drugs, blood products, CPB, pain management and stress response.

Given the multiple factors involved, it is not surprising that no single anesthetic agent has been shown to be ideal for that particular patient population and therefore, balanced anesthesia is preferred.
