Simić Dusica, Djukic Milan, Budić Ivana, Milojević Irina, Strajina Veljko
Srp Arh Celok Lek. 2011 Jan-Feb;139(1-2):107-15. doi: 10.2298/sarh1102107s.
Children with Congenital Heart Disease (CHD) presenting for non-cardiac surgery have various physiological and functional abnormalities and thus pose great challenges to the anaesthesiologist. The principles of anaesthesia are to minimize pathophysiological changes which may upset the complex interaction between systemic and pulmonary vascular resistance. Knowledge of the specific cardiac anatomy, familiarity with the modifications of the cardiorespiratory physiology, the awareness of the potential risks of complications for each individual case are mandatory for the choice of the anaesthesia strategy for each patient. During the preoperative assessment, the risk-benefit ratio should be estimated and preoperative plan established in order to optimize the preoperative status. An anaesthesiologist must also understand pharmacology of drugs being used and should tailor anaesthetic management to the type of surgery. An interdisciplinary team approach is the cornerstone for the safe delivery of anaesthesia to this paediatric patient population. The team should comprise an anesthesiologist, a paediatric cardiologist, a surgeon, a cardio-surgeon and a neonatologist. This review is meant to explain the classification of congenital heart diseases and to equip the anaesthesiologist with the necessary information about preoperative assessment, anaesthesiology management, monitoring tools important for the safe non-cardiac surgery procedures as well as therapeutic strategies during the postoperative period.
患有先天性心脏病（CHD）而需接受非心脏手术的儿童存在各种生理和功能异常，因此给麻醉医生带来了巨大挑战。麻醉的原则是尽量减少可能扰乱体循环和肺循环血管阻力之间复杂相互作用的病理生理变化。了解特定的心脏解剖结构、熟悉心肺生理的改变、知晓每个病例潜在的并发症风险，对于为每位患者选择麻醉策略而言是必不可少的。在术前评估期间，应估计风险效益比并制定术前计划，以优化术前状态。麻醉医生还必须了解所用药物的药理学知识，并应根据手术类型调整麻醉管理。跨学科团队方法是为这类儿科患者安全实施麻醉的基石。该团队应包括一名麻醉医生、一名儿科心脏病专家、一名外科医生、一名心脏外科医生和一名新生儿科医生。本综述旨在解释先天性心脏病的分类，并为麻醉医生提供有关术前评估、麻醉管理、对安全的非心脏手术程序至关重要的监测工具以及术后治疗策略的必要信息。
