ArticleCureus2024
Anesthesia Management for Epicardial Pacemaker Electrode Implantation in a Patient With a History of Fontan Procedure: A Case Report.
Article in Cureus, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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1 citing paper in PubMed.
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
One-lung ventilation is commonly used in lateral open chest surgery; however, it can increase pulmonary vascular resistance, which negatively affects Fontan circulation. Nevertheless, one-lung ventilation has a positive indication in post-Fontan patients. It allows surgery with lateral minimally invasive thoracotomy, which does not require a median sternotomy. Post-Fontan patients often have strong adhesions around the sternum and mediastinum due to multiple surgeries. Even worse, the large vessels sometimes adhere to the sternum, and a median sternotomy risks major hemorrhage. Since such risks can be avoided, one-lung ventilation is beneficial. Herein, we report our experience of one-lung ventilation anesthesia management for a post-Fontan patient who underwent pacemaker electrode implantation by right-sided minimally invasive thoracotomy. The Fontan circulation has a low tolerance for hypoxemia, so immediate treatment is necessary if hypoxemia develops during one-lung ventilation. Therefore, we connected the dependent lung side of the double-lumen tube to the anesthesia circuit and the nondependent lung side to the Jackson-Rees circuit, thereby completely separating the dependent and nondependent lungs. The Jackson-Rees circuit is highly versatile because the valve can be set to open and close freely, allowing the valve to be opened completely to administer oxygen, semi-closed to apply continuous positive airway pressure to the nondependent lungs, or ventilate the nondependent lungs at any desired time. We used this circuit to address hypoxemia during one-lung ventilation. Upon initiating one-lung ventilation, central venous pressure (CVP) increased from 8 to 19 mmHg, and SpO
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