[Anesthesia for non-cardiac surgery after Fontan repair]

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Anesthesiology

Context:

• Significant advancements in pediatric cardiology, interventional techniques, imaging, surgery, anesthesia, and critical care over 30 years have improved survival rates for congenital heart diseases.
• Over 85% of children with congenital heart diseases now survive into adulthood.
• The Fontan procedure, a staged univentricular repair for complex congenital heart defects, is typically completed before age 5, resulting in altered physiology at each stage.

Purpose:

• To highlight the complexity of anesthetic care for non-cardiac surgery in adult survivors of the Fontan procedure.
• To emphasize the necessity of a thorough understanding of Fontan physiology for anesthesiologists.
• To guide the development of specific anesthetic strategies for this patient population.

Summary:

• The Fontan procedure involves staged surgical repairs leading to a unique cardiopulmonary physiology.
• This altered physiology presents significant challenges for anesthetic management during non-cardiac surgical procedures.
• Anesthesiologists must possess precise knowledge of Fontan physiology to anticipate potential complications and implement effective management strategies.

Impact:

• Improved anesthetic protocols for Fontan patients undergoing non-cardiac surgery.
• Reduced perioperative morbidity and mortality in this complex patient group.
• Enhanced collaboration between cardiologists and anesthesiologists for optimal patient outcomes.