Cardiothoracic surgery

Congenital heart disease occurs in around 1% of live births and will be more common in children presenting for surgical correction of other congenital anomalies. Whilst the anaesthetic care of children undergoing cardiac surgery is a highly specialized area of practice, any anaesthetist looking after children and young adults will encounter patients with congenital heart disease and therefore requires an understanding of optimal anaesthetic management of these children. The objects of this chapter are first to describe different congenital heart lesions and their implications with respect to anaesthesia and to provide advice for anaesthetic care of these patients. More specialist areas of anaesthetic care are also discussed, including anaesthesia for cardiac surgery in children, anaesthesia in the cardiac catheter laboratory, and use of mechanical support of the circulation. The second part of the chapter concerns surgery on thoracic structures other than the heart. Indications for thoracic surgery, general conduct of anaesthesia, analgesic techniques, and techniques for one-lung ventilation in children are described. Mediastinal surgery and surgery on the chest wall are also discussed.