Anesthetic management of laparoscopic pheochromocytoma excision in a patient with a Fontan circulation: a case report.
10.4097/kjae.2014.66.3.252
- Author:
Hyung Chul LEE
1
;
Karam NAM
;
Ji Hyun LEE
;
Yong Hee PARK
;
Hee Soo KIM
;
Chong Sung KIM
;
Jin Tae KIM
Author Information
1. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea. kimjintae73@dreamwiz.com
- Publication Type:Case Report
- Keywords:
Fontan procedure;
General anesthesia;
Laparoscopic surgery;
Pheochromocytoma
- MeSH:
Adolescent;
Anesthesia, General;
Carbon Dioxide;
Cardiac Output;
Catecholamines;
Fontan Procedure;
Hemodynamics;
Humans;
Laparoscopy;
Male;
Pheochromocytoma*;
Pneumoperitoneum;
Vascular Resistance
- From:Korean Journal of Anesthesiology
2014;66(3):252-255
- CountryRepublic of Korea
- Language:English
-
Abstract:
An 18-year-old male with a Fontan circulation underwent excision of a pheochromocytoma after conversion from laparoscopic surgery. The pneumoperitoneum established for laparoscopic surgery may have adverse effects on the Fontan circulation, because it increases the intra-abdominal pressure (IAP), intra-thoracic pressure, pulmonary vascular resistance, and systemic vascular resistance (SVR), and decreases cardiac preload and cardiac output. Meticulous monitoring is also required during carbon dioxide exsufflation, because a rapid decrease in IAP can provoke hemodynamic deterioration by decreasing venous return and SVR. Furthermore, catecholamines released by the pheochromocytoma can worsen the hemodynamic status of Fontan circulation during surgery. Therefore, sophisticated intraoperative anesthetic care is required during laparoscopic pheochromocytoma excision in patients with a Fontan circulation.
