• Takashi Fujii, Soichi Shirakawa, Yasushi Matsuura, Shunsuke Yamamoto, and Takekazu Terai.
• Department of Anesthesiology, Osaka Rosai Hospital, Sakai 591-8025.
• Masui. 2010 Aug 1; 59 (8): 1025-7.

AbstractAdvances in the surgical and medical management of children with congenital heart disease have decreased the mortality of these patients. As a result, more patients are surviving into adulthood and are presenting for noncardiac surgery. We experienced a case of anesthetic management of an adult patient with Fontan circulation for laparoscopic surgery. A 29-year-old woman was scheduled for laparoscopic cholecystectomy for gallbladder stone. She had undergone single-ventricle procedures for a tricuspid atresia, and at the time of the laparoscopic surgery, her cardiac physiology was Fontan circulation. To reduce the influence of the increased intraabdominal pressure on hemodynamics, the insufflation pressure was maintained at 8 cmH2O during pneumoperitoneum. To reduce systemic and pulmonary vascular resistance, milrinon was administered intravenously. Throughout the operation, including the period of pneumoperitoneum, the hemodynamic status remained stable, and adequate oxygenation and ventilation were maintained. The surgery ended uneventfully, and the trachea was extubated in the operating room. In anesthetic management of patients with Fontan circulation for laparoscopic surgery, it is important to understand the physiology of the circulation, and consider the influence of the pneumoperitoneum on the hemodynamics.

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