Anesthetic Complications in Surgery for Congenital Heart Disease

Anesthetic complications in 500 consecutive operations for congenital heart disease were studied and their contribution to mortality and morbidity were assessed. The great majority of the cases were young and sick children in ASA Class III, IV, or V with complex congenital heart disease. Anesthetic mortality was zero and hospital mortality was 6.3%. Anesthetic complications occurred in 2% of the cases. Four major complications were seen, including two tension pneumothoraces, one episode of severe hypotension on induction, and a breathing circuit malfunction on induction leading to bradycardia and hypotension. Six minor complications included two cases of premature extubation that required reintubation postoperatively, one case of subglottic edema, airway obstruction from inadvertent tracheal insertion of an esophageal temperature probe, one corneal abrasion, and one case of erosion of the nasal ala secondary to a nasotracheal tube. Half of the complications were probably preventable, but the other half of the complications occurred despite specific attempts at their prevention.