Anesthesia Management of Scoliosis Correction in an Adolescent with Fontan Circulation Secondary to Hypoplastic Left Heart Syndrome: A Case Report

Abstract

Fontan Scoliosis Anesthetic Challenges For any child with a Fontan circulation, anesthetic challenges for correction of thoracic deformity, when combined with single-ventricle physiology and the potentially for compromising transpulmonary flow and cardiac output, can lead to increased complexity. We present the perioperative and anesthetic course for an 11-year-old girl with HLHS status post extracardiac, nonfenestrated Fontan, who underwent surgery for correction of adolescent idiopathic scoliosis. An 11-year-old girl with HLHS underwent correction of scoliosis using total intravenous anesthesia with propofol and fentanyl without paralysis, enabling intraoperative neuromonitoring; intraoperative ventilation, hemodynamic goals, and anesthetic management focused on maintaining adequate transpulmonary blood flow; the intraoperative 4-hour operation remained relatively bloodless and hemo-dynamically stable, the patient remained free of need for any pressor support, and was intubated and extubated prior to departure to pediatric intensive care. This patient and this report contribute to the sparse literature available concerning the anesthesia care for scoliosis correction in patients with Fontan physiology.