Guidelines for anaesthesia of adults with congenital heart disease in non-cardiac surgery.

OBJECTIVE

To provide guidelines for the anesthetic management of adults with congenital heart disease for non-cardiac surgery.

DESIGN

A consensus committee of 16 experts was convened. A formal conflict-of-interest (COI) policy was developed at the beginning of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e., pharmaceutical, medical devices). The authors were required to follow the rules of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE®) system to guide the assessment of the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized.

METHODS

The committee studied 10 questions within 4 fields: preoperative evaluation, intraoperative management, postoperative care, and obstetrics. Each question was formulated in a PICO (Patients Intervention Comparison Outcome) format and evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology.

RESULTS

The experts' synthesis work and the application of the GRADE® method resulted in 11 expert opinions. Some of the questions did not find any response in the literature. After one round of scoring, a strong agreement was reached for all recommendations.

CONCLUSIONS

There was strong agreement among experts for 10 recommendations to improve practices for the anesthetic management of adults with congenital heart disease for non-cardiac surgery.