Laparoscopic Cholecystectomy in a Patient with Glenn Shunt-Aided with Erector Spine Block

Area of Science:

• Cardiology
• Anesthesiology
• Pediatric Surgery

Background:

• Patients with single ventricular physiology often undergo bidirectional (BD) Glenn shunt or hemi-Fontan procedures for temporary cardiac support.
• These patients increasingly require non-cardiac surgical interventions, posing significant anesthetic challenges.
• The erector spinae block (ESP) is a recognized analgesic technique for thoracoabdominal surgeries, potentially suitable for this patient group.

Purpose of the Study:

• To describe the anesthetic management of a patient with complex congenital heart disease (CHD) and a history of BD Glenn shunt undergoing laparoscopic surgery.
• To evaluate the safety and efficacy of the erector spinae block (ESP) for perioperative analgesia in such a high-risk patient.
• To discuss the anesthetic considerations and challenges associated with non-cardiac surgery in patients with a history of BD Glenn shunt.

Main Methods:

• A detailed preoperative assessment and meticulous hemodynamic monitoring were employed.
• General anesthesia was administered for a laparoscopic cholecystectomy.
• The erector spinae block (ESP) was utilized for perioperative analgesia.

Main Results:

• The patient, a 17-year-old female with complex CHD and prior BD Glenn shunt, underwent a successful laparoscopic cholecystectomy.
• The perioperative period was managed successfully with close monitoring and effective analgesia via ESP.
• No major adverse events related to cardiac function or anesthesia were reported.

Conclusions:

• Anesthetic management for non-cardiac surgery in patients with a history of BD Glenn shunt requires a comprehensive understanding of their unique physiology.
• The erector spinae block (ESP) can be a safe and effective analgesic modality in these challenging cases.
• Careful planning of anesthetic agents, cardiovascular support, and ventilation strategies is crucial for successful outcomes.