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Manejo anestésico de la ventilación de un solo pulmón en un paciente de Fontan

Richard Coulie1, Francis Ryckaert1, Evgeny Raevsky2

  • 1Department of Perioperative Medicine, Bart's Heart Centre, Barts Health NHS Trust, London, GBR.

Cureus
|September 4, 2025
PubMed
Resumen

La administración de anestesia para pacientes adultos con circulación de Fontan sometidos a cirugía, como la revisión de plomo del marcapasos con ventilación de un pulmón, es compleja. Este caso y la revisión enfatizan la atención especializada para mejorar los resultados perioperatorios.

Palabras clave:
la circulación de las fuentesToracotomía lateralventilación de un solo pulmón (OLV)Reposicionamiento del plomo del marcapasosResistencia vascular pulmonar

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Área de la Ciencia:

  • Cardiología
  • Anestesiología
  • Cirugía torácica

Sus antecedentes:

  • Los pacientes adultos con circulación de Fontan presentan desafíos fisiológicos únicos para la cirugía no cardíaca.
  • La administración anestésica requiere una cuidadosa consideración de la hemodinámica alterada y la perfusión de órganos.

Objetivo del estudio:

  • Para describir el manejo anestésico de un paciente de Fontan sometido a revisión de plomo del marcapasos epicárdico toracoscópico bajo ventilación de un pulmón.
  • Revisar la literatura existente sobre la ventilación de un solo pulmón en pacientes con Fontan para informar las estrategias perioperatorias.

Principales métodos:

  • Manejo anestésico y hemodinámico detallado de un paciente Fontan de 39 años.
  • Revisión sistemática de los casos publicados de ventilación por un solo pulmón en Fontan Physiology.

Principales resultados:

  • Finalización exitosa de la revisión de plomo del marcapasos utilizando monitoreo avanzado, soporte inotrópico y vasodilatadores pulmonares.
  • Identificación de riesgos perioperatorios significativos y necesidad de un enfoque multidisciplinario.

Conclusiones:

  • La revisión electiva del marcapasos epicárdico es factible en pacientes con Fontan con una planificación meticulosa de la anestesia.
  • Un equipo especializado y multidisciplinario es crucial para optimizar la atención perioperatoria y los resultados en esta población de alto riesgo.