Thoracic epidural anesthesia for cholecystectomy in a patient after Fontan procedure
Arai, M.; Kanai, A.; Matsuzaki, S.; Takenaka, T.; Kato, S.
Masui. Japanese Journal of Anesthesiology 46(2): 271-275
1997
ISSN/ISBN: 0021-4892 PMID: 9071115 Document Number: 482790
A 12 year-old boy who had received modified Fontan procedure was scheduled for cholecystectomy. Anesthesia was maintained with thoracic epidural anesthesia (Th8-9) and O-2-N-2O-sevoflurane under mechanical ventilation through the endotracheal tube. Transesophageal echo cardiography and mixed venous oxygen saturation (S hivin vO-2) were used for hemodynamic monitoring. The combined use of epidural anesthesia and volatile anesthetics decreased central venous pressure, left ventricular end diastolic volume, left ventricular ejection fraction and S hivin VO-2. These hemodynamic problems were easily solved by infusion therapy and a low dose of dopamine. On the other hand, there were also some hemodynamic benefits such as inhibition of tachycardia and suppression of an increase in pulmonary vascular resistance due to surgical stress. Moreover, patient returned to normal spontaneous breathing with complete analgesia during the early phase after surgery. CVP and S ovrhdot VO-2 increased to preoperative values in the recovery room. From these results, we conclude that satisfactory results can be obtained with epidural anesthesia for upper abdominal surgery after Fontan procedure.