[Giant cerebral aneurysm with fontan circulation].
The population of children undergoing successful surgery for congenital heart disease (CHD) continues to increase. Increasing number of patients with a Fontan circulation is reaching adulthood and requiring anesthesia for noncardiac surgeries. We anesthetized a patient with a Fontan circulation (9 years old) for giant internal carotid-ophthalmic artery aneurysm trapping. There was a difficulty in cannulating internal jugular vein for measuring central venous pressure because of abnormal collateral arteries around the internal jugular vein. Central venous pressure of around 15 mmHg seemed appropriate to keep good hemodynamic condition during this surgery. In this condition, cerebral cortex was not edematous. Careful management of circulatory volume stabilized hemodynamic state. However, when heart rate decreased below 75, ectopic atrial rhythm occured. Anesthetic time was 13 hr and 40 min. The patient was extubated in the operating room. We have to take into consideration that there are anatomical abnormalities and arrhythmia in the patients with a Fontan circulation.
Miyazaki
Shinichiro
S
Department of Anesthesiology, National Cardiovascular Center, Suita.
Shinzawa
Masahide
M
Yoshitani
Kenji
K
Nohmi
Toshihiro
T
Ohnishi
Yoshihiko
Y
D000771:Anesthesia, Intravenous; D002343:Carotid Artery, Internal / Q000601:surgery; D002648:Child; D003399:Craniotomy; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D009880:Ophthalmic Artery / Q000601:surgery; D010880:Piperidines; D015742:Propofol; D000077208:Remifentanil; D014656:Vascular Surgical Procedures
D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol