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How Does One Safely Anesthetize a Univentricular Patient for Noncardiac Surgery?Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, University of Arizona Health Sciences Center, Tucson, AZ. As the surgical, perioperative, and pediatric management of univentricular patients advances, more anesthesiologists will see these challenging patients as children, teenagers, and adults come to the operating room for common noncar diac surgeries: tonsillectomy, appendectomy, labor and de livery, etc. The univentricular heart has 2 atrioventricular valves with 1 ventricular chamber or a large dominant ven tricle associated with a diminutive opposing ventricle. The common pathway of physiology is complete mixing of blood. Blood pressure and oxygen saturation are dependent on the ratio of pulmonary vascular resistance (PVR) to sys temic vascular resistance (SVR). A thorough history and physical examination give the anesthesiologist insight into what further laboratory evaluations and interventions are needed. The 3 key issues with respect to echocardiographic evaluation of the heart are ventricular function, atrioventric ular valve insufficiency, and pulmonary artery stenosis or distortion. After completion of the ventricular bypass proce dures, the hemodynamics rely on the homeostasis of the PVR/SVR ratio, ventricular performance, and oxygen deliv ery. Therefore, the univentricular physiology is best served by spontaneous ventilation. Intraoperative and postopera tive pain management is key to facilitating extubation of the patient's trachea and subsequently expediting recovery from surgery.
Seminars in Cardiothoracic and Vascular Anesthesia, Vol. 5, No. 1,
40-45 (2001) |
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