Anesthesia and Acid-Base Status in Congenital Heart Disease

During the induction period, especially in the case of cyanotic patients, straining, crying, and fighting should be avoided because they raise the intraalveolar pressure, leading to reduced pulmonary perfusion, increased pulmonary vascular resistance, and hence increased right-to-left shunting with worsening of systemic hypoxia. They also increase intra-thoracic pressure and impede the venous return, leading to a decrease in cardiac output. Therefore, we highly recommend that heavier sedation or premedication than that regularly used in pediatric cases be given one hour prior to induction.