Outcomes of general anesthesia for noncardiac surgery in a series of patients with Fontan palliation
Article first published online: 23 SEP 2012
© 2012 Blackwell Publishing Ltd
Volume 23, Issue 2, pages 180–187, February 2013
How to Cite
Rabbitts, J. A., Groenewald, C. B., Mauermann, W. J., Barbara, D. W., Burkhart, H. M., Warnes, C. A., Oliver, W. C., Flick, R. P. (2013), Outcomes of general anesthesia for noncardiac surgery in a series of patients with Fontan palliation. Pediatric Anesthesia, 23: 180–187. doi: 10.1111/pan.12020
- Issue published online: 3 JAN 2013
- Article first published online: 23 SEP 2012
- Manuscript Accepted: 26 JUL 2012
- single ventricle;
- congenital heart disease;
To describe the experience of a single, tertiary care institution in the care of patients with Fontan physiology undergoing anesthesia for noncardiac surgery.
The Fontan procedure was developed in 1971 to palliate patients with univentricular cardiac physiology leading to long-term survival of these patients, who may now present as adults for noncardiac surgery.
We retrospectively reviewed the medical records of Fontan patients 16 years and older who underwent general anesthesia for noncardiac surgery at Mayo Clinic in Rochester, Minnesota. Preoperative data, perioperative course, intraoperative and postoperative hemodynamic, pulmonary, cardiovascular, and renal complications were described.
Thirty-nine general anesthetics were administered to 31 patients for noncardiac surgery after Fontan palliation. Perioperative complications occurred in 12 of the 39 (31%) noncardiac surgeries, and there was one postoperative death that occurred on day 13 after ventral hernia repair. The two patients who had complications that did not resolve (long-term dialysis and death) had ejection fractions well below the mean for the group (22% and 28%).
It may be more appropriate for Fontan patients to undergo anesthesia for noncardiac surgery in a tertiary institution, particularly patients with an ejection fraction of <30%. Intraoperative arterial blood pressure monitoring and overnight admission are likely appropriate for most cases.