Spinal anesthesic approach in pediatric patients with congenital cardiac disease for non-cardiac surgery

In recent years,the number of patients with congenital cardiac anomalies who underwent corrective or palliative surgery in neonatal period has increased markedly. this growing population emerges as children and young adults in later years. noncardiac surgery in children with congenital heart disease (chd) may be associated with increased risk of morbidity and mortality. the primary physiological effect of heart disease and detailed understanding of cardiac pathology is important for the choice of suitable anesthetic technique. therefore,in these patients anesthetic assessment should be directed to the patient's current disease. in recent literature,the safe use of newer anesthetic agents,such as sevoflurane or desflurane in combination with opioids or regional blocks have been reported in pediatric patients with congenital cardiac disease. nowadays the number of publications for the use of spinal anesthesia during non-cardiac surgeiy has also been increasing in children with congenital cardiac pathologies. careful peroperative assesment,experienced anesthesiologists,appropriate use of anesthetic agents and techniques,and the invasive monitoring are important parts of safe and effective anesthetic management in children with congenital heart disease,in this review,specific considerations and spinal anesthetic approach of patients with congenital cardiac disease undergoing non-cardiac surgeiy are summarized.