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Updated: Jun 22, 2026
18:50
Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
[Giant cerebral aneurysm with fontan circulation].
Shinichiro Miyazaki1, Masahide Shinzawa, Kenji Yoshitani
1Department of Anesthesiology, National Cardiovascular Center, Suita.
Masui. the Japanese Journal of Anesthesiology
|June 16, 2009
Summary
Children with Fontan circulation are increasingly needing anesthesia for noncardiac surgery. Careful management of hemodynamics and awareness of potential anatomical abnormalities and arrhythmias are crucial for successful outcomes.
Area of Science:
- Cardiology
- Anesthesiology
- Pediatric Surgery
Background:
- The number of children surviving congenital heart disease (CHD) with Fontan circulation is rising.
- Adults with Fontan circulation require anesthesia for noncardiac procedures, presenting unique challenges.
Observation:
- Anesthesia was administered to a 9-year-old patient with Fontan circulation for a complex aneurysm surgery.
- Difficulties in central venous pressure monitoring arose due to collateral vessels.
- Maintaining central venous pressure around 15 mmHg and careful volume management were key to hemodynamic stability.
Findings:
- Ectopic atrial rhythm occurred when heart rate dropped below 75 bpm.
- The patient's cerebral cortex remained non-edematous throughout the procedure.
- Successful extubation was achieved in the operating room after a 13-hour, 40-minute anesthetic duration.
Implications:
- Anesthesiologists must consider potential anatomical variations and arrhythmias in Fontan patients.
- This case highlights the importance of meticulous hemodynamic management in this population.
- Further research into anesthetic strategies for Fontan patients undergoing noncardiac surgery is warranted.
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