Congenital Heart Disease Considerations

Children with congenital heart disease (CHD) are at an increased risk for sedation-related complications. The number of these patients with unrepaired or palliated disease requiring procedural sedation outside of the operating room continues to increase as staged surgeries and techniques are associated with better survival. CHD patient characteristics associated with the highest risk of sedation-related complications include age less than 2 years; single-ventricle physiology, including hypoplastic left heart syndrome; left ventricular outflow tract obstruction; cardiomyopathy with impaired ventricular function; and pulmonary hypertension. Before sedating a child with CHD, providers must recognize the anatomic variations, surgical history, and physiologic implications for each individual patient. An understanding of the hemodynamic principles involved in managing intracardiac shunts is essential. Commonly used sedation medications in patients with CHD and their potential adverse effects are discussed, as well as presedation and postsedation considerations.