Anesthesia for noncardiac surgery in pediatric patients following cardiac transplantation

Pediatric cardiac transplantation has been performed with increasing frequency to treat hypoplastic left heart syndrome and other types of congenital heart disease. A large number of these patients will require anesthesia posttransplantation for noncardiac surgery. A review of our series of 92 anesthetics in 46 patients has better defined perioperative risk factors, anesthetic management, common surgical procedures, and complications associated with noncardiac surgery in posttransplantation patients. Anesthetic management concerns include allograft coronary artery disease, graft rejection, denervation, cardiac dysrhythmias, immunosuppression, cyclosporine-induced hypertension, drug interactions, renal dysfunction, and intravenous access problems. Preoperative evaluation must include the possibility and definition of these problems. Medically stable patients undergoing noncardiac/nonthoracic surgery after cardiac transplantation undergo the same surgical procedures as similarly aged nontransplantation patients. Similar induction techniques can be used as in nontransplantation patients. These patients may also be scheduled for same-day surgery if other significant medical problems are not present and the difficulty of the surgery is compatible with an outpatient setting. Patients with more complex medical problems, including chronic rejection, significant coronary artery disease, or a history of congestive failure may need overnight monitoring in a hospital setting despite that only a minor surgical procedure is being performed.