Anesthetic management of laparoscopic pheochromocytoma excision in a patient with a Fontan circulation: a case report
Korean Journal of Anesthesiology 2014³â 66±Ç 3È£ p.252 ~ p.255
ÀÌÇüö(Lee Hyung-Chul) - Seoul National University Hospital Department of Anesthesiology and Pain Medicine
ÀÌÁöÇö(Lee Ji-Hyun) - Seoul National University Hospital Department of Anesthesiology and Pain Medicine
³²°¡¶÷(Nam Ka-Ram) - Seoul National University Hospital Department of Anesthesiology and Pain Medicine
¹Ú¿ëÈñ(Park Yong-Hee) - Seoul National University Hospital Department of Anesthesiology and Pain Medicine
±èÈñ¼ö(Kim Hee-Soo) - Seoul National University Hospital Department of Anesthesiology and Pain Medicine
±èÁ¾½Â(Kim Chong-Sung) - Seoul National University Hospital Department of Anesthesiology and Pain Medicine
±èÁøÅÂ(Kim Jin-Tae) - Seoul National University Hospital Department of Anesthesiology and Pain Medicine
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.
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Fontan procedure, General anesthesia, Laparoscopic surgery, Pheochromocytoma
KMID :
0356920140660030252
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