Neurosurgery in a child with cyanotic congenital heart disease (CCHD): Is cardiac grid formulation the panacea?

Cyanotic congenital heart disease (CCHD) is often associated with more than one cardiac anomaly with unique hemodynamic pattern, hence presenting a plethora of challenges to non-cardiac anesthesiologists. Understanding the pathophysiology of the cardiac lesion and constructing a cardiac grid can help in determining intraoperative hemodynamic goals and facilitate smooth perioperative management of such patients. This case report describes the anesthetic management of an infant with dextro-transposition of great arteries (dTGA) with a large atrial septal defect, ventricular septal defect, severe pulmonary stenosis, and patent ductus arteriosus posted for excision and repair of occipital meningocele and highlights the role of cardiac grid in clarifying anesthetic goals and ensuring better outcomes.