Korean J Anesthesiol.  2014 Mar;66(3):252-255. 10.4097/kjae.2014.66.3.252.

Anesthetic management of laparoscopic pheochromocytoma excision in a patient with a Fontan circulation: a case report

• Lee HC
• Nam K
• Lee JH
• Park YH
• Kim HS
• Kim CS
• Kim JT

• KMID: 2092455
• DOI: http://doi.org/10.4097/kjae.2014.66.3.252

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.

Keyword

Fontan procedure; General anesthesia; Laparoscopic surgery; Pheochromocytoma

MeSH Terms

Adolescent
Anesthesia, General
Carbon Dioxide
Cardiac Output
Catecholamines
Fontan Procedure
Hemodynamics
Humans
Laparoscopy
Male
Pheochromocytoma*
Pneumoperitoneum
Vascular Resistance
Carbon Dioxide
Catecholamines