The anesthetic technique is dictated by
the presence of cardiac disease. Consider premedication, use measures to
limit increases in pulmonary artery pressure (prevent hypercarbia, maintain
PaO2). If the pulmonary and systemic circulations are in parallel as in
the hypoplastic left heart syndrome, strict attention must be paid to
maintaining the balance of flow to the pulmonary and systemic vascular beds,
primarily by manipulating pulmonary vascular resistance.