**1. Introduction**

56 Perioperative Considerations in Cardiac Surgery

Warren O, Mandal K, Hadjianastassiou V, Knowlton L, Panesar S, John K, Darzi A,

Wong DT, Cheng DC, Kustra R, Tibshirani R, Karski J, Caroll-Munro J, Sandler A (1999).

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halothane or isoflurane. *Anesthesiology* 1988; 69: 552-65 Online ISSN:1528-1175 Print

Athanasiou T. (2007). Recombinant activated factor VII in cardiac surgery: A systematic review. *Ann Thorac Surg* 2007; 83: 707-714 Online ISSN: 1552-6259 Print

Risk factors of delayed extubation, prolonged lenght of stay in the intensive care unit, and mortality in patients with fast-track cardiac anesthesia: A new Cardiac risk score. Anesthesiology 1999; 91: 936-944 Online ISSN:1528-1175 Print ISSN:0003-

> Incidence of congenital heart disease (CHD) is about 0.8%1 and most of these CHD children (80%) survive to adulthood in developed countries due to early diagnosis and intervention along with improved surgical and anaesthetic techniques. But the situation is different in most of the third world countries, where 90% of these children receive suboptimal or no care2. These patients commonly admitted in the hospital for procedures like cardiac catheterization, radiological procedures3 4, dental and cardiac surgery.

> There is increased risk of mortality and morbidity5 under anaesthesia as their anaesthetic management in the operating room is challenging in several respect. Few heart defects are so complex that you need to involve paediatric cardiologist and intensivist for complete understanding of anatomy and pathophysiology of heart defect.

> Adult population with congenital heart defects has also increased6 7 over the years and poses more challenges for anaesthesiologist in perioperative period. It is now expected that soon there will be more adult with congenital heart defects than children. Grown up congenital heart (GUCH) is a separate entity, which requires expertise of different disciplines to prevent associated morbidity and mortality8 during operations (cardiac or non cardiac) particularly in uncorrected defects and in pregnant patients.

> When a cardiac defect is recognized in a paediatric patient then the presence of other cardiac and extracardiac lesion is a possibility. The incidence of extra cardiac malformation is as high as 20 – 45% and chromosomal abnormalities in these CHD patients is found to be 5-10%.

> Perioperative anaesthetic considerations include preoperative evaluation, management of hypoxaemia, shunt, polycythaemia, pulmonary hypertension and ventricular dysfunction.
