Anesthetic management for the pediatric patient undergoing deep hypothermic circulatory arrest

Early definitive repair of complex congenital heart defects is now advocated. For the completion of many of these repairs, the use of deep hypothermic circulatory arrest (DHCA) is an absolute necessity. Unfortunately, there is undeniable neurologic morbidity, as well as other complications associated with DHCA. Anesthesiologists can aid in minimizing these unfortunate complications with the appropriate anesthetic management. Areas of current controversy in managing pediatric patients undergoing DHCA, which will be covered in this article, include cardiopulmonary bypass strategies (low-flow cardiopulmonary bypass versus DHCA), arterial blood gas management, hemodilution effects, glucose management, and the use of steroids, barbiturates, and antifibrinolytics. Every institution varies in their techniques, and there is always some new insight to be gained from discussion of these differences. At this time, anesthesiologists and surgeons alike are striving to gain further understanding of what truly occurs with the use of DHCA and in turn apply this clinically to provide better care for all pediatric patients undergoing this unique management.