Anesthetic Management of Surgical Repair of Coarctation of Aorta in Neonates and Infants

Coarctation of aorta (CoA) is a localized narrowing of descending thoracic aorta most commonly between left subclavian artery and ductus arteriosus causing proximal hypertension and distal hypoperfusion. The clinical presentation of CoA in neonates and infants varies from acute hemodynamic collapse to weak or absent arterial femoral pulsation. Keeping the patency of ductus arteriosus with prostaglandin E1 infusion is lifesaving, once the diagnosis of severe CoA is established. Transthoracic echocardiography is the cornerstone for the diagnosis and follow-up of CoA. Inotropic drugs such as dobutamine, dopamine and epinephrine are indicated to maintain and stabilize the hemodynamics in neonates and infants with acute heart failure. Resection of the constricted segment with end to end anastomosis is the standard surgical approach. Preductal invasive arterial pressure monitoring via an arterial catheter placed in the right arm is essential. During surgery, passive cooling of the patients to a temperature of 35°C is recommended in to reduce the risk of neurological injury. Clamping the aorta aggravates the proximal hypertension and cause distal body hypoperfusion with increased risk of spinal cord injury. The aim of this review is to declare the anesthetic management of neonates and infants undergoing surgical correction of CoA and how to reduce the risk of aortic cross clamping.