title: Laparoscopic colectomy in an adult with single ventricle physiology: anesthetic implications and management.
abstract: Increasing numbers of adult patients with complex congenital heart conditions are presenting for noncardiac surgery later in life. These disorders can present challenges for surgical and anesthesia providers. Specifically, single ventricle lesions offer anatomic and physiologic concerns during the perioperative period. Single ventricle physiology represents a delicate balance between systemic and pulmonary blood flow. Any alterations in blood flow through these systems can produce undesirable hemodynamic changes, especially during the perioperative period. We present a case of an adult patient with a single left ventricle who presented for laparoscopic total colectomy due to inflammatory bowel disease. His abnormal anatomy coupled with the hemodynamic disruptions caused by laparoscopy presented significant anesthetic challenges. We highlight the anesthetic concerns of single ventricle physiology, specifically pertaining to laparoscopic surgery. We provide recommendations for safely managing these patients perioperatively. With detailed preoperative evaluation and close hemodynamic monitoring during the perioperative period, these patients can experience successful surgical and anesthetic outcomes.
authors: Department of Anesthesia, Division of Cardiothoracic Anethesia, Mayo Clinic Hospital, Phoenix, AZ, USA.
authors: Kelly J
authors: KJ
authors: Zach
authors: Harish
authors: H
authors: Ramakrishna
authors: Krishnashwamy
authors: K
authors: Chandrasekaran
authors: Ricardo A
authors: RA
authors: Weis
mesh_terms: D000328:Adult; D000758:Anesthesia / Q000379:methods*; D018686:Anesthetics, Intravenous; D003082:Colectomy; D005045:Etomidate; D005283:Fentanyl; D006330:Heart Defects, Congenital / Q000150:complications* / Q000000981:diagnostic imaging; D006352:Heart Ventricles / Q000002:abnormalities* / Q000000981:diagnostic imaging; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D009467:Neuromuscular Depolarizing Agents; D013390:Succinylcholine; D014463:Ultrasonography
chemical_list: D018686:Anesthetics, Intravenous; D009467:Neuromuscular Depolarizing Agents; D013390:Succinylcholine; D005283:Fentanyl; D005045:Etomidate