Anesthetic Management of a Child From the Qinghai-tibet Plateau With a Double Outlet Right Ventricle and Severe Polycythemia: A Case Report

Abstract Background Acquired secondary polycythemia is common in patients with a double outlet right ventricle, and results from tissue hypoxia. Secondary erythrocytosis can cause coagulation deficiencies, and increases the risks of thrombosis and infarction. Perioperative management in double outlet right ventricle patients with severe erythrocytosis is intractable, and only a few cases have been reported. Case presentation: Herein, we report the anesthetic management of a 10-year-old female patient with a double outlet right ventricle. She lived in the low-oxygen Qinghai−Tibet Plateau, and presented with severe polycythemia (hemoglobin, 24.8 g/dL; hematocrit, 75%). She underwent a modified Fontan surgery, which was satisfactory and without any perioperative complications. Our anesthetic management highlights the importance of perioperative hemodilution to decrease the risk of thromboembolism, and correction of coagulopathy to prevent hemorrhage. Conclusions Anesthetic management is challenging in rare cyanotic congenital heart disease patients with severe polycythemia. For prevention of thrombosis and hemorrhage, it is important to adopt perioperative hemodilution and correction of coagulopathy.

Download Full-text

Anesthetic management of repair of exomphalus and extrophy of the bladder for a neonate with double outlet right ventricle with atrial septal defect

The Internet Journal of Anesthesiology ◽

10.5580/16ee ◽

2009 ◽

Vol 22 (1) ◽

Keyword(s):

Right Ventricle ◽

Atrial Septal Defect ◽

Septal Defect ◽

Anesthetic Management ◽

Double Outlet Right Ventricle

Download Full-text

Carotid approach to anterior circulation thromboembolectomy in an adult with failing fontan physiology: a case report

BMC Anesthesiology ◽

10.1186/s12871-021-01364-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Caroline Eden ◽

Hugo Clifford ◽

Arthur Wang ◽

Asif Mohammed ◽

Peter Yim

Keyword(s):

Anesthetic Management ◽

Pressure Control ◽

Double Outlet Right Ventricle ◽

Anterior Circulation ◽

Case Presentation ◽

Airway Control ◽

Physiological Alterations ◽

Cardiopulmonary Monitoring ◽

Fontan Physiology ◽

Failing Fontan

Abstract Background Anesthetic management of an adult with failing Fontan physiology is complicated given inherent anatomical and physiological alterations. Neurosurgical interventions including thromboembolectomy may be particularly challenging given importance of blood pressure control and cerebral perfusion. Case Presentation We describe a 29 year old patient born with double outlet right ventricle (DORV) with mitral valve atresia who after multi-staged surgeries earlier in life, presented with failing Fontan physiology. She was admitted to the hospital almost 29 years after her initial surgeries to undergo workup for a dual heart and liver transplant in the context of a failing Fontan with elevated end diastolic pressures, NYHA III heart failure symptoms, and liver cirrhosis from congestive hepatopathy. During the workup in the context of holding anticoagulation for invasive procedures, she developed a middle cerebral artery (MCA) stroke requiring a thromboembolectomy via left carotid artery approach. Discussion and Conclusions This case posed many challenges to the anesthesiologist including airway control, hemodynamic and cardiopulmonary monitoring, evaluation of perfusion, vascular access, and management of anticoagulation in an adult patient in heart and liver failure with Fontan physiology undergoing thromboembolectomy for MCA embolic stroke.

Download Full-text

Perioperative management of patients with acromegaly-a retrospective analysis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20180290 ◽

2018 ◽

Vol 6 (2) ◽

pp. 515

Author(s):

Nethra H. Nanjundaswamy ◽

Raghavendra Biligiri Sridhara

Keyword(s):

Retrospective Analysis ◽

Perioperative Management ◽

Perioperative Complications ◽

Anesthetic Management ◽

Preoperative Evaluation ◽

Electrolyte Imbalance ◽

Cervical Disc ◽

Visual Field Defects ◽

Cardiac Complications ◽

Presenting Symptoms

Background: Acromegaly poses several challenges to the anesthetists, neurosurgeons, endocrinologists and intensivists, mandating a careful, coordinated multidisciplinary approach for a successful surgical outcome. An emphasis is required on a thorough preoperative evaluation of airway, neurological and endocrine and metabolic status so as to formulate a suitable perioperative management plan.Methods: The rates of various perioperative complications, both surgical and anesthesia related, during pituitary surgeries in acromegaly patients were studied. Data collected included demographics, patient’s medical history and any associated comorbid conditions, diagnosis, procedure performed, anesthetic management, intraoperative and postoperative complications.Results: This is a retrospective analysis of 22 patients of acromegaly who underwent excision of a growth hormone (GH) secreting pituitary adenoma from October 2012 to December 2017. Male: female, 14:8 with a mean age of 32±9.5 years. The common presenting symptoms were somatic dysmorphism, headache, visual field defects and menstrual irregularities. Preoperative associated co-morbidities were hypertension (4), diabetes mellitus (6), Ischemic Heart Disease (1), hypothyroidism (3), situs solitus (1), lumbar and cervical disc prolapse (1), nephropathy (1) and poliomyelitis (1). One patient had difficult tracheal intubation with repeated attempts at direct laryngoscopy and surgery was deferred to a later date where awake fibreoptic bronchoscopic intubation was done. Two more patients with anticipated difficult airway, trachea was intubated using a fibreoptic bronchoscope. Out of 22 Transsphenoidal surgical approach (transnasal or sublabial) and pterional craniotomy in 18 and 4. Inhalational anaesthetic was used in the majority of patients (isoflurane, 18 and sevoflurane, 03) propofol infusion was used in 1 patient. Intraoperative cardiac complications like hypertension, ventricular ectopics was seen. Postoperatively metabolic, water and electrolyte imbalance were common occurance. CSF rhinorrhoea in 4 patients and one developed meningitis.Conclusions: The present data shows that patients undergoing pituitary surgery for acromegaly have many airway issues, cardiac and metabolic risk factors.

Download Full-text

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

Journal of Obstetric Anaesthesia and Critical Care ◽

10.4103/2249-4472.104738 ◽

2012 ◽

Vol 2 (2) ◽

pp. 109 ◽

Cited By ~ 1

Author(s):

PM Singh ◽

Anjan Trikha ◽

Shubhangi Arora ◽

Vimi Rewari ◽

AkhilKant Singh

Keyword(s):

Right Ventricle ◽

Perioperative Management ◽

Pulmonary Stenosis ◽

Double Outlet Right Ventricle

Download Full-text

Anesthetic management of tracheoesophageal fistula repair in a newborn with a double-outlet right ventricle

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2011.01.010 ◽

2011 ◽

Vol 23 (8) ◽

pp. 643-645

Author(s):

Heather McClung ◽

Rajeev Prasad ◽

Roy Schwartz

Keyword(s):

Right Ventricle ◽

Tracheoesophageal Fistula ◽

Anesthetic Management ◽

Double Outlet Right Ventricle ◽

Fistula Repair

Download Full-text

Epidural Anesthesia for Cesarean Section in a Pregnant Woman with Marfan Syndrome and Dural Ectasia

Case Reports in Obstetrics and Gynecology ◽

10.1155/2017/2126310 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Franco Pepe ◽

Mariagrazia Stracquadanio ◽

Francesco De Luca ◽

Agata Privitera ◽

Elisabetta Sanalitro ◽

...

Keyword(s):

Cesarean Section ◽

Cesarean Delivery ◽

Marfan Syndrome ◽

Epidural Anesthesia ◽

Perioperative Management ◽

Perioperative Complications ◽

Genetic Disorder ◽

Anesthetic Management ◽

Previous Pregnancy ◽

Dural Ectasia

Marfan syndrome (MFS) is a genetic disorder of connective tissue, characterized by variable clinical features and multisystem complications. The anesthetic management during delivery is debated. Regional anesthesia has been used with success during cesarean delivery, but in some MFS patients there is a probability of erratic and inadequate spread of intrathecal local anesthetics as a result of dural ectasia. In these cases, epidural anesthesia may be a particularly useful technique during cesarean delivery because it allows an adequate spread and action of local anesthetic with a controlled onset of anesthesia, analgesia, and sympathetic block and a low risk of perioperative complications. We report the perioperative management of a patient with MFS and dural ectasia who successfully underwent cesarean section using epidural technique anesthesia. The previous pregnancy of this woman ended with cesarean section with a failed spinal anesthesia that was converted to general anesthesia due to unknown dural ectasia at that time.

Download Full-text