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[Anesthetic management of an adult patient with Fontan circulation for laparoscopic surgery]

Takashi Fujii1, Soichi Shirakawa, Yasushi Matsuura

  • 1Department of Anesthesiology, Osaka Rosai Hospital, Sakai 591-8025.

Masui. the Japanese Journal of Anesthesiology
|August 19, 2010
PubMed

Insights

Anesthetic management for adults with Fontan circulation undergoing laparoscopic surgery requires careful hemodynamic monitoring. This case study highlights successful management by controlling insufflation pressure and administering milrinone.

Area of Science:

  • Cardiology
  • Anesthesiology
  • Pediatric Surgery

Background:

  • Improved treatments for congenital heart disease lead to increased adult survivors.
  • Adults with complex congenital heart conditions require non-cardiac surgical interventions.
  • Fontan circulation presents unique anesthetic challenges in adult patients.

Observation:

  • A 29-year-old female with a history of tricuspid atresia and Fontan circulation underwent laparoscopic cholecystectomy.
  • Anesthetic management focused on mitigating hemodynamic instability caused by pneumoperitoneum.
  • Low insufflation pressure (8 cmH2O) and intravenous milrinone were employed.

Findings:

  • Hemodynamic status remained stable throughout the laparoscopic procedure.
  • Adequate oxygenation and ventilation were successfully maintained.
  • The patient was extubated in the operating room without complications.

Implications:

  • Understanding Fontan physiology is crucial for safe anesthetic care during non-cardiac surgery.
  • Careful control of intra-abdominal pressure and systemic/pulmonary vascular resistance is vital.
  • This case demonstrates the feasibility of laparoscopic surgery in adult Fontan patients with meticulous anesthetic planning.

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