Surgical and anaesthetic risks in adults born with OA/TOF

All patients born with OA/TOF are regarded as high-risk patients for general anaesthetic and need careful assessment by an anaesthetist pre-surgery. Whilst this is outside the purview of primary care, it is worth highlighting key risk factors covered elsewhere in the leaflet so that these can be discussed with any surgeon when referring for routine surgery. Not all risk factors will be present in all patients, and severity varies between patients.

• Vocal cord paralysis. As discussed elsewhere, many adults with OA/TOF have this, and this makes intubation more difficult and riskier, as any further damage can be catastrophic.
• Unsafe swallow and severe GORD. Some adults with OA/TOF will choke on their own secretions, and this as well as GORD and gastroparesis increases risk of aspiration under anaesthetic.
• This makes maintenance of a patent airway during anaesthetic more difficult.
• Adhesions from childhood surgery can mean simple surgeries become much more complex, such as gall bladder removal. The number of adhesions will also become more pronounced with increasing number of childhood surgeries.