Transfenestration Doppler Assessment During Laparoscopic Pheochromocytoma Resection in a Patient With Fontan Circulation

Hara, Mitsuyoshi; Hyodo, Ayako; Kimura, Hiroko; Hiraki, Teruyuki

doi:10.1053/j.jvca.2022.04.046

Cited by 1 publication

(2 citation statements)

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“…In particular, this approach is conducive to completing the operation without interference from intra-abdominal adhesions, as seen in case 3. Laparoscopic surgery is challenging for Fontan physiology because the pneumoperitoneum increases SVR and decreases venous return and cardiac output [8,12,14]. Although the pneumoperitoneum pressure was set at 6-8 mmHg, CVP and ABP were stable in our case.…”

Section: Discussionmentioning

confidence: 75%

“…Chronic hypoxia exposure followed by aberrant activation of common hypoxia cellular pathways and hypoxia-inducible factors in chromaffin cells appear to mechanism for the pathogenesis of P-PGL [1]. Although several case reports of P-PGL with Fontan circulation have been reported, the information on its perioperative anesthetic management is sparse (online only Supplement) [3][4][5][6][7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Anesthetic management of pheochromocytoma and paraganglioma for patients with Fontan circulation: a case series

et al. 2023

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Background Anesthetic management of pheochromocytoma and paraganglioma with Fontan circulation is challenging for physicians, with attention to cardiovascular physiology. Case presentation We performed anesthetic management for pheochromocytoma and paraganglioma in three patients with Fontan circulation. We maintained intraoperative central venous pressure at preoperative level under fluid infusion and administrating nitric oxide to decrease pulmonary arterial resistance. We administered noradrenaline or vasopressin if low blood pressure was present despite adequate central venous pressure. Although noradrenaline is prevalent for the case of noradrenaline-secreting tumor especially after resection, we could maintain blood pressure to administrate vasopressin without increasing central venous pressure. Retroperitoneal laparoscopic approach which could avoid intra-abdominal adhesions might be selectable as case 3. Conclusions Sophisticated management is required for pheochromocytoma and paraganglioma with Fontan circulation.

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Section: Discussionmentioning

confidence: 75%