A case series of different anesthesia approaches for single ventricular physiology patients in various stages of palliation underwent noncardiac procedures

Background: Glenn procedure is a Palliative surgical procedure performed as a step of staged repair for patients with single ventricle such as tricuspid atresia and hypoplastic left heart syndrome. It is usually performed at about three to six months of age, directs systemic venous blood directly from the superior vena cava to the pulmonary circulation. A significant burn injury affects almost all organs. Understanding the complex and pathophysiological responses in the early and late phases of injury is imperative to provide care in the acute and perioperative period. Large airway and lung edema can occur rapidly and unpredictably after burn. Hemodynamics changes in the early phase of severe burn injury are characterized by a reduction in cardiac output and increased systemic and pulmonary vascular resistance. Case Summary: We report the management of a single ventricle patient with its challenges and unique consideration and major burn with its problems. She underwent serial debridement, extensive skin grafting to all burn areas. The patient had hemoglobin of 8.7 g/dl, she was on dopamine infusion to maintain blood pressure which was difficult to measure by BP cuff, the extremities were not an option to use as monitoring sites. Upon arrival, her oxygen saturation (SpO2) was being monitored with a disposable pulse oximetry sensor through the ear lobule, at times monitoring was disrupted and disappeared. We managed to use an oral airway to measure oxygen saturation through soft palate successfully and after transfusion we could wean off inotropic support. Conclusion: Patients with Glenn shunt whose acceptable oxygen saturation is 75-80% need hemoglobin level above 13 g/dl. Measurements of capillary density using reflectance oximetry through the soft palate provide very reliable SpO2 measurements.

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Anesthetic management of a single ventricle pediatric patient with a major burn injury, case report

Mahmoud¹,

Aboalfaraj

Almalki

et al. 2020

Egyptian Journal of Anaesthesia

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Anesthetic management of a single-ventricle pediatric patient with scoliosis: A case report

Aboalfaraj

Sindi²,

Mahmoud³

et al. 2022

IJCA

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Single ventricle is a complex cardiac disease which carry high morbidity and mortality and the average 3 years survival rate without Fontan procedure was approximated to be 75%. The most common etiologies are: hypoplastic left heart syndrome and tricuspid atresia. When those patient plan to go for surgery, it’s very essential for anesthetist to understand how the physiology is affected rather than etiology. BT shunt patency, right ventricular function and pulmonary artery pressure should be evaluated before any procedure under anesthesia. Scoliosis corrective surgery is a procedure that has its special considerations related to restrictive pulmonary disease, prone positioning, and major bleeding that may occur, which altogether will add to the risk when being conducted in a single-ventricle patient and will necessitate vigilance and special care during monitoring intraoperatively. Here, we report a simple way to monitor the transpulmonary pressure gradient through two central lines in the femoral and jugular veins as part of the patient’s anesthesia management.

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Anaesthetic Challenges and Transesophageal Echocardiography-Guided Perioperative Management in a Patient with Uncorrected Adult Congenital Heart Disease Presenting for Emergency Laparoscopic Hysterectomy

Waje

Chatterjee

Arora

et al. 2021

Turk J Anaesthesiol Reanim

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Anaesthetic management of a patient with adult congenital heart disease with a single ventricle physiology presenting for an emergency laparoscopic surgery is challenging. The importance of a multidisciplinary approach, astute understanding of the pathophysiology and optimisation of intraoperative hemodynamic goals cannot be overemphasised. The present report describes the anaesthetic challenges and the role of transoesophageal echocardiography in perioperative management of a patient with uncorrected tetralogy of Fallot with pulmonary atresia, who successfully underwent an emergency laparoscopic hysterectomy under general anaesthesia.

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A case series of different anesthesia approaches for single ventricular physiology patients in various stages of palliation underwent noncardiac procedures

Cited by 3 publications

References 9 publications

Anesthetic management of a single ventricle pediatric patient with a major burn injury, case report

Anesthetic management of a single ventricle pediatric patient with a major burn injury, case report

Anesthetic management of a single-ventricle pediatric patient with scoliosis: A case report

Anaesthetic Challenges and Transesophageal Echocardiography-Guided Perioperative Management in a Patient with Uncorrected Adult Congenital Heart Disease Presenting for Emergency Laparoscopic Hysterectomy

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