Anesthetic management for non-cardiac surgery in a patient with Fontan palliation: case report
Survival of patients with Fontan palliation has improved significantly over the years and it constitutes a condition frequently found nowadays in the perioperative setting for non-cardiac surgery. A history of this disease condition implies complex physiologic and multiorgan considerations for the anesthetist who may need to resort to special measures in order to maintain homeostasis and avoid complications. In this paper we present the case of a patient with a history of Fontan, and describe successful anesthetic management during laparoscopic surgery.
2. Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax 1971;26:240-248.
3. Windsor J, Townsley MM, Briston D, et al. Fontan palliation for single-ventricle physiology: perioperative management for non-cardiac surgery and analysis of outcomes. J Cardiothorac Vasc Anesth 2017;31:2296-2303.
4. Attard C, HuangJ, Monagle P, et al. Pathophysiology of thrombosis and anticoagulation post Fontan surgery. Thromb Res 2018; 172:204-213.
5. Dennis M, Zannino D, Du Plessis K, et al. Clinical outcomes in adolescents and adults after the Fontan procedure. J Am Coll Cardiol 2018;71:1009-1017.
6. D'Udekem Y, Iyengar AJ, Cochrane AD, et al. The Fontan procedure: contemporary techniques have improved long-term outcomes. Circulation 2007;116 (11 suppl):I157-I164.
7. Rychik J, Kim Y. The adolescent and adult with a Fontan circulation: “Unnatural” selection and survival of the fittest. J Am Coll Cardiol 2018;71:1018-1020.
8. Goldberg DJ. The Fontan operation improved outcomes, uncertain future. J Am Coll Cardiol 2015;66:1711-1713.
9. Ohuchi H. Where is the “optimal” Fontan hemodynamics? Korean Circ J 2017;47:842-857.
10. Kaba A, Joris J. Anaesthesia for laparoscopic surgery. Curr Anaesth Crit Care 2001;12:159-165.
11. Mayer J, Boldt J, Poland R, et al. Continuous arterial pressure waveform-based cardiac output using the flotrac/vigileo: a review and meta-analysis. J Cardiothorac Vasc Anesth 2009;23:401-406.
12. Carpio-Domínguez DLE, Ma D, Patricia R. Is Vigileo useful in thoracic anesthesia? Rev Mex Anestesiol 2017;40:138-139.
13. Al-Rifai Z, Mulvey D. Principles of total intravenous anaesthesia: practical aspects of using total intravenous anaesthesia. BJA Educ 2016;16:276-280.
14. Onk D, Ayazoglu TA, Onk OA, et al. Comparison of TIVA and desflurane added to a subanaesthetic dose of propofol in patients undergoing coronary artery bypass surgery: evaluation of hae-modynamic and stress hormone changes. Biomed Res Int 2016; 2016:3272530.