title: Anesthetic Management of Parturients With a Fontan Circulation: A Review of Published Case Reports.
abstract: Parturients with Fontan physiology provide unique and complex challenges to anesthesiologists. Such challenges include the maintenance of a perfect balance between preload, pulmonary vascular resistance, afterload, and cardiac output in a setting of a single ventricle physiology. The physiological changes of pregnancy add additional burden to an already "fragile" physiology, making the anesthetic management for labor and/or cesarean delivery even more complex. Understanding the impact of these changes on the Fontan physiology and the effect of anesthetic choices on this dyad (pregnancy-Fontan) is an imperative prior to caring for these patients. In an effort to determine how these patients are best managed for labor and/or cesarean delivery, we have reviewed the literature examining the peripartum anesthetic management of parturients with Fontan circulation and have identified 27 case reports.
authors.affiliation: University of Virginia, Charlottesville, VA, USA mt9y@virginia.edu.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Tiouririne
authors.affiliation: University of British Columbia, Kelowna, British Columbia, Canada.
authors.forename: Duncan G
authors.initials: DG
authors.lastname: de Souza
authors.affiliation: Riverside Methodist Hospital, Columbus, OH, USA.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Beers
authors.affiliation: University of Virginia, Charlottesville, VA, USA.
authors.forename: Terrance A
authors.initials: TA
authors.lastname: Yemen
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000776:Anesthesiology / Q000379:methods; D000777:Anesthetics / Q000008:administration & dosage; D002585:Cesarean Section / Q000379:methods; D005260:Female; D018729:Fontan Procedure; D006801:Humans; D007743:Labor, Obstetric / Q000502:physiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000503:physiopathology*; D055815:Young Adult
chemical_list: D000777:Anesthetics
keywords: Fontan circulation; analgesia; congenital heart disease; high-risk systems; pregnancy