Anesthetic management of a child with complete atrioventricular septal defect and single ventricle posted for noncardiac surgery

Congenital heart defects are associated with various physiological disturbances. They pose anesthetic challenges for both cardiac and noncardiac surgeries. Atrioventricular septal defects are due to a developmental failure in the separation of atria and the ventricles into separate chambers and failure in the separation of mitral and tricuspid valves. We present a case of a child (1½ years), weighing 10 kg, diagnosed as congenital hydrocephalus who was planned for ventriculoperitoneal shunt. Child was having an oxygen saturation of 76% on room air. Anesthesia was induced with morphine and propofol. After tracheal intubation, saturation improved to 93%. Anesthesia was maintained with a combination of oxygen and nitrous oxide along with isoflurane. Measures were taken to maintain normovolemia and avoid hypotension, hypoxia, tachycardia, cardiac dysrhythmias and acidosis. The patient remained hemodynamically stable, maintaining arterial blood gasses within normal limits. The overall intraoperative course remained uneventful. At the end of the procedure, patient was reversed with neostigmine 60 mcg/kg and glycopyrrolate 10 mcg/kg. Extubation was done after the child was alert and opening eyes and was shifted to intensive care on oxygen inhalation for further monitoring.