Anesthetic Management of Resection of Metastatic Occipital Malignancy in a Patient With Fontan Physiology

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.

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Anesthetic Management of a Patient with Fontan Physiology for Laparoscopic Cholecystectomy

Nepalese Heart Journal ◽

10.3126/njh.v17i2.32681 ◽

2020 ◽

Vol 17 (2) ◽

pp. 51-53

Author(s):

Santosh Sharma Parajuli

Keyword(s):

Laparoscopic Cholecystectomy ◽

Survival Rate ◽

General Anesthesia ◽

Female Patient ◽

Anesthetic Management ◽

Surgical Techniques ◽

Medical Sciences ◽

Cardiac Abnormalities ◽

Fontan Physiology ◽

Fontan Palliation

With the modification in surgical techniques and advancement in medical sciences, the survival rate of patients with complex cardiac abnormalities has increased to more than 90% in about 10 years after Fontan palliation. These patients can present with some form of non-cardiac surgeries during their lifetime. Better understanding of Fontan physiology can help in proper perioperative anesthetic management of these patients. Our cases was of a 17-year-old female patient with Fontan physiology for her Ebstein's Anomaly, planned for Laparoscopic Cholecystectomy under general anesthesia. Here we describe how we successfully managed the case perioperatively.

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Anesthetic management for the peripartum care of women with fontan physiology

International Journal of Obstetric Anesthesia ◽

10.1016/j.ijoa.2021.103210 ◽

2021 ◽

pp. 103210

Author(s):

M. McCabe ◽

N. An ◽

J. Aboulhosn ◽

J. Schwarzenberger ◽

M. Canobbio ◽

...

Keyword(s):

Anesthetic Management ◽

Fontan Physiology

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Das rupturierte infrarenale Aortenaneurysma – eine kritische Analyse

VASA ◽

10.1024/0301-1526.28.1.30 ◽

1999 ◽

Vol 28 (1) ◽

pp. 30-33 ◽

Cited By ~ 9

Author(s):

Bürger ◽

Meyer ◽

Tautenhahn ◽

Halloul

Keyword(s):

Aortic Aneurysm ◽

Aortic Rupture ◽

Anesthetic Management ◽

Objective Evaluation ◽

Left Ventricular ◽

Apache Ii ◽

Apache Ii Score ◽

Infrarenal Aortic Aneurysm ◽

Emergency Situations ◽

Probability Of Death

Background: Objective evaluation of the management of patients with ruptured infrarenal aortic aneurysm in emergency situations has been described rarely. Patients and methods: Fifty-two consecutive patients with ruptured infrarenal aortic aneurysm (mean age, 70.3 years; range, 56–89 years; SD 7.8) were admitted between January 1993 and March 1998. Emergency protocols, final reports, and follow-up data were analyzed retrospectively. APACHE II scores at admission and fifth postoperative day were assessed. Results: The time between the appearance of first symptoms and the referral of patients to the hospital was more than 5 hours in 37 patients (71%). Thirty-eight patients (71%) had signs of shock at time of admission. Ultrasound was performed in 81% of patients as the first diagnostic procedure. The most frequent site of aortic rupture was the left retroperitoneum (87%). Intraoperatively, acute left ventricular failure occurred in four patients, and cardiac arrest in two others. The postoperative course was complicated significantly in 34 patients. The overall mortality rate was 36.5% (n = 19). In 35 patients, APACHE II score was assessed, showing a probability of death of more than 40% in five patients and lower than 30% in 17 others. No patient showing probability of death of above 75% at the fifth postoperative day survived (n = 7). Conclusions: Ruptured aortic aneurysm demands surgical intervention. Clinical outcome is also influenced by preclinical and anesthetic management. The severity of disease as well as the patient’s prognosis can be approximated using APACHE II score. Treatment results of heterogenous patient groups can be compared.

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Successful Endovascular Repair of a Leaking Abdominal Aortic Aneurysm under Local Anesthesia

Swiss Surgery ◽

10.1024/1023-9332.7.2.86 ◽

2001 ◽

Vol 7 (2) ◽

pp. 86-89 ◽

Cited By ~ 17

Author(s):

Lachat ◽

Pfammatter ◽

Bernard ◽

Jaggy ◽

Vogt ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Ct Scan ◽

Local Anesthesia ◽

Endovascular Repair ◽

Anesthetic Management ◽

High Risk Patient ◽

Invasive Technique ◽

Chronic Obstructive ◽

Abdominal Aortic

Local anesthesia is a safe and less invasive anesthetic management for the endovascular approach to elective aortic aneurysm. We have successfully extended the indication of local anesthesia to a high-risk patient with leaking aneurysm and stable hemodynamics. Patient and methods: A 86 year old patient with renal insufficiency due to longstanding hypertension, coronary artery and chronic obstructive lung disease was transferred to our hospital with a leaking abdominal aortic aneurysm. Stable hemodynamics allowed to perform a fast CT scan, that confirmed the feasibility of endovascular repair. A bifurcated endograft (24mm x 12mm x 153mm) was implanted under local anesthesia. Results: The procedure was completed within 85 minutes without problems. The complete sealing of the aneurysm was confirmed by CT scan on the third postoperative day. Twenty months later, the patient is doing well and radiological control confirmed complete exclusion of the aneurysm. Discussion: The endoluminal treatment is a minimally invasive technique. It's feasibility can be rapidly assessed by CT scan. The transfemoral implantation can be performed under local anesthesia provided that hemodynamics are stable. This anesthetic management seems to be particularly advantageous for leaking abdominal aortic aneurysm since it doesn't change the hemodynamic situation in contrast to general anesthesia. Hemodynamic instability, abdominal distension or tenderness may indicate intraperitoneal rupture and conversion to open graft repair should be performed without delay.

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Anesthesia for rabbits submitted to experimental surgeries: Report of a series of eight anesthesias

Panorama brasileiro de tungstênio (w) entre os anos de 2008 e 2014 ◽

10.32749/nucleodoconhecimento.com.br/health/anesthesia-for-rabbits ◽

2020 ◽

pp. 151-158

Author(s):

Rafael Antonio Caldart Bedin ◽

Maisa Schultz ◽

Antonio Bedin

Keyword(s):

Muscle Relaxation ◽

Anesthetic Management ◽

Laboratory Animals ◽

Average Weight ◽

Anesthetic Induction ◽

Anesthetic Agents ◽

Reasonable Degree ◽

Bioethical Debate ◽

Precordial Stethoscope

Anesthesia for laboratory animals is a matter of biomedical concern and one of the most present dilemmas in the current bioethical debate. The use of anesthetic agents in experimental surgery aims at analgesia and restraining the animal, in order to achieve a reasonable degree of muscle relaxation and to produce sufficient analgesia. This practice requires the use of protocols for the administration of safe and efficient doses. Eight New Zealand rabbits were submitted to laparotomies demonstrating the surgical technique discipline of the local medical course. For pre-anesthetic medication, acepromazine 1 mg.kg-1 associated with ketamine 15 mg.kg-1 was used subcutaneously. Anesthesia was maintained with isoflurane and oxygen under a laryngeal mask in a Mapleson D anesthesia system and under spontaneous breathing. Hydration was performed with 10 ml.kg-1 saline every hour. A thermal mattress was used. Precordial stethoscope, pulse oximetry and clinical parameters were used for monitoring. For euthanasia, ketamine 10 mg.kg-1 associated with potassium chloride 19.1% 1 ml.kg-1 was used intravenously. The average weight of the rabbits was 2721.25 ± 275.01 grams and the duration of the anesthetic procedure was 120 ± 87 minutes. Discussion. In long-term anesthesia, such as laparotomies, the use of pre-anesthetic medication and then anesthetic induction by the combination of agents is recommended. However, anesthetic management requires monitoring to prevent insufficient or excessive doses from occurring.

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