Page 28 - CASA Bulletin of Anesthesiology Vol 9 (4) 2022 (3)

CASA Bulletin of Anesthesiology

hemodynamics and decrease the risk of ventilator associated sedation and complications. When a
Fontan patient has other severe comorbidities such as severe restrictive lung disease or unstable
hemodynamics, delayed extubation may be necessary, and appropriate pain management and
sedation should be provided.

Conclusion

A thorough preoperative evaluation and planning, maintenance of normovolemia, avoidance
of myocardial depression, avoidance of factors which will increase PVR, endocarditis
prophylaxis, appropriate monitoring and good postoperative pain control are essential for
successful outcome in this group of patients.

References
1. Fontan, F. and E. Baudet, Surgical repair of tricuspid atresia. Thorax, 1971. 26(3): p. 240-8.
2. Schilling, C., et al., The Fontan epidemic: Population projections from the Australia and New Zealand Fontan
Registry. Int J Cardiol, 2016. 219: p. 14-9.
3. de Leval, M.R., et al., Total cavopulmonary connection: a logical alternative to atriopulmonary connection for
complex Fontan operations. Experimental studies and early clinical experience. J Thorac Cardiovasc Surg, 1988.
96(5): p. 682-95.
4. Edgcombe, H., K. Carter, and S. Yarrow, Anaesthesia in the prone position. Br J Anaesth, 2008. 100(2): p. 165-
83.
5. Brown, Z.E., et al., Changes in cardiac index and blood pressure on positioning children prone for scoliosis
surgery. Anaesthesia, 2013. 68(7): p. 742-6.
6. Rafique, M.B., E.A. Stuth, and J.C. Tassone, Increased blood loss during posterior spinal fusion for idiopathic
scoliosis in an adolescent with Fontan physiology. Paediatr Anaesth, 2006. 16(2): p. 206-12.
7. Hedequist, D.J., J.B. Emans, and J.E. Hall, Operative treatment of scoliosis in patients with a Fontan circulation.
Spine (Phila Pa 1976), 2006. 31(2): p. 202-5.

P a g e 27 | 65