Tetralogia De Fallot

General Anesthesia
The emphasis of anesthetic management during carotid surgery is on maintaining adequate cerebral perfusion without stressing the heart.
Traditionally, this is accomplished byclose regulation of arterial blood pressure and avoidance of tachycardia. Mean arterial blood pressure should be maintained at—or slightly above—the patient's usual range.
Monitoring of intraarterialpressure is therefore mandatory. Electrocardiographic should include the V5 lead to detect ischemia.
Thiopental, propofol, and etomidate are the most popular choices for induction their havefavorable cerebral effects, reducing cerebral metabolic rate proportionately more than cerebral blood flow. Propofol and etomidate appear to lack the same protective effects as thiopental in focal ischemia,but propofol allows more rapid awakening.
Small doses of an opioid or B-adrenergic blocker can be used to blunt the hypertensive response to endotracheal intubation.
Isoflurane may be the volatileagent of choice because it appears to provide the greatest protection against cerebral ischemia.

Nitroglycerin is usually a good choice for mild to moderate hypertension because of its beneficialeffects on the coronary circulation. Marked hypertension requires a more potent agent, such as nitroprusside. B-Adrenergic blockade facilitates management of the hypertension and prevents tachycardia,but should be used cautiously.

Nicardipine may be a good alternative because of its possible protective effect in focal ischemia.
Hypotension should be treated with judicious amounts ofintravenous fluid and/or vasopressors. Some clinicians consider phenylephrine the vasopressor of choice; if selected, it should be administered in 25-µg increments to prevent excessive hypertension.
Pronouncedor sustained reflex bradycardia or heart block caused by manipulation of the carotid baroreceptor should be treated with atropine.
Arterial CO2 tension should be routinely measured because...