The patient with a history of congenital heart disease who is to undergo ambulatory surgery.

PURPOSE OF REVIEW: There is a strong pressure to widen the indications of ambulatory anaesthesia in children. Making a decision concerning a child with a history of cardiac disease is often difficult. The aim of this review is to give practical recommendations to help the anaesthesiologist recognize potentially dangerous situations in children with a history of cardiac disease.

RECENT FINDINGS: The anaesthetic care of a child with a history of heart disease presenting for an ambulatory procedure includes three steps: understanding the pathophysiology of the child's current haemodynamic status, checking whether he/she is actually eligible for outpatient anaesthesia and planning the safest anaesthetic plan, accordingly. The concept of congenital heart disease nowadays includes not only congenital heart defects but also congenital dysrythmias such as congenital long QT and Brugada syndromes, and acquired lesions such as sequellae of Kawasaki disease. Children with a partially corrected or palliated cardiac defect tolerate poorly hypovolaemia, systemic hypotension and hypoxaemia. They should thus not undergo on an ambulatory basis procedures during or after which such problems can occur. Moreover, postoperative analgesia should be carefully planned with the parents.

SUMMARY: A child whose cardiac disease has been corrected, who is developing well, has no exercise restriction and undergoes regular cardiologic follow-up does not present more risks than any normal American Society of Anesthesiologists physical status 1-2 child. Any other situation requires close communication with the child's paediatric cardiologist to evaluate the risks of both anaesthesia and outpatient care, and make an individualized decision accordingly.