Anaesthetic Management during Transposition of Great Arteries (TGA) Correction: Points to be Focussed

Transposition of great arteries (TGA) is combination of concordant atrioventricular and discordant ventriculo-arterial connections and is divided into dextro-looped (d-TGA) and levo-looped (l-TGA) based on whether the atria and ventricles are concordant or discordant, respectively. Arterial switch operation is the procedure of choice but other surgical surgical options exists. In our case, a 4 month old boy presented with cyanosis, delayed milestone, diagnosed d-TGA with ASD came for surgical repair. Arterial switch repair was planned but due to decreased right ventricular pressure and raised pulmonary arterial pressure, mustard-senning procedure was performed. Hypoxia, systemic hypoxemia, metabolic acidosis, hypercarbia, sympathetic nervous stimulation due to light plane of anaesthesia can trigger a rapid rise in PVR, and even a pulmonary hypertensive crisis. Our aim was to prevent alteration in SVR and PVR in order to prevent desaturation especially at time of induction and off CPB bypass.