Obstetric anaesthetic management in a patient with the Fontan circulation

Successful epidural anesthesia for cesarean delivery in a woman with Fontan repair

“…These goals are can be best accomplished with neuraxial anesthesia [12][13][14][15], although some have used general anesthesia successfully [12,16]. Recent modeling suggests that PVR is the major determinant of preload and, thus, cardiac output in Fontan physiology [17]; and given that PVR progressively increases over time when presented with nonpulsatile flow [11], it is likely that phosphodiesterase inhibitors or inhaled nitric oxide may be needed.…”

Emergency cesarean section in a patient with Fontan circulation using an indwelling epidural catheter

“…There is an increasing number of patients of childbearing age who have undergone a Fontan procedure [5][6][7]. Although some of the physiologic changes are reversed by the operation, the fundamental anomalies remain and the operation is considered to be palliative.…”

Anesthetic management of pediatric patients following fontan operation

“…In addition, the use of this kind of drug for patients with a Fontan circulation is controversial [3][4][5]. However, we were concerned that our patient's heart might not tolerate the short period of hypotension until the initiation of transfusion because coronary perfusion may be impaired following hypotension.…”

“…Positive pressure ventilation reduces venous return and hence decreases pulmonary blood flow. Thus, local anesthesia may be more favorable to maintain spontaneous ventilation [3,4]. However, pediatric patients cannot tolerate major surgery with regional anesthesia.…”