Anesthetic management of noncardiac surgery for patients with single ventricle physiology

Abstract

Patients with congenital heart diseases are a growing population, and noncardiac surgeries will become an important health care issue. Patients with single ventricle physiology are a particularly challenging population who will undergo staged, palliative repair toward a final step of Fontan circulation. Although Fontan surgery creates a serial circulation in which the ventricle pumps blood to the systemic circuit, pulmonary blood flow occurs without a dedicated ventricle. Despite progress in outcomes, this abnormal circulation remains associated with various co-morbidities such as ventricular dysfunction, arrhythmias, protein losing enteropathy, and plastic bronchitis. Health care professionals must prepare for these patients to present to noncardiac surgery at any stage of intervention, possibly with complications. Given that staged, palliative repair has undergone multiple modifications, patients who present for surgery can vary in types and timing of the repair. Anesthesiologists who care for them must be familiar with perioperative issues to optimize outcomes, especially because congenital heart disease is a risk factor for increased mortality for noncardiac surgery.

Parturient with double outlet right ventricle without pulmonary stenosis: Perioperative management

“…[6] The circuit with lower resistance would preferentially be perfused. [7] A fall in systemic vascular resistance (SVR) in these patients leads to further reduction in pulmonary blood fl ow, which impedes oxygenation.…”

Spinal Anesthesia in Circumcision Operation in a Child with Bidirectional Superior Cavapulmonary Shunt

“…Arousal or light anesthesia can elevate PVR. It is pointed out that elevated PVR may cause decreased pulmonary blood flow and systemic hypoxemia after a BCPS (2) . The goal of intraoperative management is to maintain an adequate intravascular volume to enhance PBF, and minimize PVR in patients with BCPS (2) .…”

“…It is pointed out that elevated PVR may cause decreased pulmonary blood flow and systemic hypoxemia after a BCPS (2) . The goal of intraoperative management is to maintain an adequate intravascular volume to enhance PBF, and minimize PVR in patients with BCPS (2) . General anesthesia and endotracheal intubation may induce abnormal hemodynamic and respiratory response and life threatening bronchospasm in patients with BCPS.…”

Assessing the Risks of Noncardiac Surgery for Children With Congenital Heart Disease∗

“…Although the subject of anesthesia care for patients with CHD has been reviewed (2)(3)(4), in practice, clinicians still face innumerable questions daily for which there are few data. How should these patients be Such a recommendation may be difficult for families with limited resources, which is a topic worthy of discussion.…”