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Anesthetic Management
in Fontan Circulation
Dr.Al Johara Hamza
Consultant Cardiac Anesthetist
Prince Sultan Cardiac Center
11/21/2012
Univentricular Heart
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Ventricular dysfunction.
Arrhythmias.
Thromboembolism.
Shunts.
Protein losing enteropathy.
Developmental deficit.
Anaesthetic Management
A full understanding of the physiology
of the Fontan circulation is essential
for ensuring optimal anesthetic
management of these patients.
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Anaesthetic Management
The main determinants of the success of the Fontan
circulation:
SVR.
PVR.
AV function.
Cardiac rhythm.
Ventricular function.
Anaesthetic Management
Preoperative Assessment.
Monitoring.
Induction and Maintenance.
Mechanical ventilation.
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Preoperative Assessment
History.
Examination.
Investigation.
Monitoring
Oxygenation.
Gas analysis.
Cardiac rhythm.
Invasive arterial and CVP monitoring is
MANDATORY
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Mechanical Ventilation
Avoid increase airway pressure.
Low respiratory rate.
Short inspiratory time.
Low PEEP.
Low tidal volume (5-6 ml/kg).
Mechanical Ventilation
Disadvantages:
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Anesthetic Management
atrial distention
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Anesthetic Management
Laparoscopic Surgery
Laparoscopic Surgery
Advantages:
Reduction in post operative pain and recovery
time.
Disadvantages:
Hypercarbia.
Gas embolism.
Hemodynamic disturbance.
Pneumothorax.
Mediastinal emphysema.
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Laparoscopic Surgery
Precautions:
Keep intra abdominal pressure less than
10 mmHg to maintain the venous return
and CO.
Maintain adequate ventilation
(avoid hypercarbia).
Minimize duration of surgery.
Maintain intravascular volume.
Conclusion
Understanding the physiology of Fontan
circulation is essential for the successful
anesthetic management.
Heart function in the pregnant patient with a
Fontan circulation deteriorates throughout
pregnancy.
Laparoscopic and day care surgery is usually
well tolerated.
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THANK YOU
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