Considerations in Critical-Care and Anesthetic Management of Adult Patients Living With Fontan Circulation |
| |
| Institution: | 1. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada;2. School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada;3. Child Health Evaluative Science, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada;4. Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada;5. Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada;1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA;2. Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA;1. Jewish General Hospital, MAUDE Unit, McGill University, Montréal, Québec, Canada;2. Toronto Adult Congenital Heart Disease Program, Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada;3. University Health Network, Toronto, Ontario, Canada;4. Ohio State University Medical Center, Columbus, Ohio, USA;5. St. Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada;6. Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada;7. McGill University Health Centre, Montréal, Québec, Canada;1. Division of Cardiology, Stollery Children’s Hospital and University of Alberta, Edmonton, Alberta, Canada;2. Scottish Adult Congenital Cardiac Service, Golden Jubilee Hospital and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland;3. Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark;4. Division of Cardiology, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA;1. Department of Pediatrics (Neurology), The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada;2. Department of Pediatrics (Neurology), BC Children’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada;3. Division of Neurology, Vancouver Stroke Program, University of British Columbia, Vancouver, British Columbia, Canada |
| |
| Abstract: | The Fontan procedure is a staged palliation for various complex congenital cardiac lesions, including tricuspid atresia, pulmonary atresia, hypoplastic left heart syndrome, and double-inlet left ventricle, all of which involve a functional single-ventricle physiology. The complexity of the patients’ original anatomy combined with the anatomic and physiologic consequences of the Fontan circulation creates challenges. Teens and adults living with Fontan palliation will need perioperative support for noncardiac surgery, peripartum management for labour and delivery, interventions related to their structural heart disease, electrophysiology procedures, pacemakers, cardioversions, cardiac surgery, transplantation, and advanced mechanical support. This review focuses on the anesthetic and intensive care unit (ICU) management of these patients during their perioperative journey, with an emphasis on the continuity of preintervention planning, referral pathways, and postintervention ICU management. Requests for recipes and doses of medications are frequent; however, as in normal anesthesia and ICU practice, the method of anesthesia and dosing are dependent on the presenting medical/surgical conditions and the underlying anatomy and physiologic reserve. A patient with Fontan palliation in their early 20s attending school full-time with a cavopulmonary connection is likely to have more reserve than a patient in their late 40s with an atriopulmonary Fontan at home waiting for a heart transplant. Each case will require an anesthetic and critical care plan tailored to the situation. The critical care environment is a natural extension of the anesthetic management of a patient, with complex considerations for a patient with Fontan palliation. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
