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Outcomes of general anesthesia for noncardiac surgery in a series of patients with F ontan palliation
Author(s) -
Rabbitts Jennifer A.,
Groenewald Cornelius B.,
Mauermann William J.,
Barbara David W.,
Burkhart Harold M.,
Warnes Carole A.,
Oliver William C.,
Flick Randall P.
Publication year - 2013
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.12020
Subject(s) - medicine , perioperative , anesthesia , surgery , hemodynamics , ejection fraction , medical record , dialysis , heart failure
Summary Objectives To describe the experience of a single, tertiary care institution in the care of patients with F ontan physiology undergoing anesthesia for noncardiac surgery. Background The F ontan procedure was developed in 1971 to palliate patients with univentricular cardiac physiology leading to long‐term survival of these patients, who may now present as adults for noncardiac surgery. Methods We retrospectively reviewed the medical records of F ontan patients 16 years and older who underwent general anesthesia for noncardiac surgery at M ayo C linic in R ochester, M innesota. Preoperative data, perioperative course, intraoperative and postoperative hemodynamic, pulmonary, cardiovascular, and renal complications were described. Results Thirty‐nine general anesthetics were administered to 31 patients for noncardiac surgery after F ontan palliation. Perioperative complications occurred in 12 of the 39 (31%) noncardiac surgeries, and there was one postoperative death that occurred on day 13 after ventral hernia repair. The two patients who had complications that did not resolve (long‐term dialysis and death) had ejection fractions well below the mean for the group (22% and 28%). Conclusion It may be more appropriate for F ontan patients to undergo anesthesia for noncardiac surgery in a tertiary institution, particularly patients with an ejection fraction of <30%. Intraoperative arterial blood pressure monitoring and overnight admission are likely appropriate for most cases.