Anaes SAQs · Cardiac anaesthesia
Anaesthesia for adult congenital heart disease
Final-examination SAQ for adult-congenital-heart-disease-anaesthesia.
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ANZCAFRCAEDAICABAFCAI
Prompt
A 28-year-old with Fontan circulation needs laparoscopic cholecystectomy. Outline anaesthetic considerations.
Model answer
Physiology (4). Passive pulmonary flow; need preload, low PVR, sinus rhythm, careful mean airway pressure.[2]
Risk (2). ACHD noncardiac surgery elevated risk — specialist input.[1]
Technique (4). Experienced team; arterial line; titrated induction; ventilation avoiding hypoxia/hypercarbia; limit pneumoperitoneum; early extubation if possible; vasopressors/inotropes ready.[2]
Crises (3). Low output algorithm; arrhythmia cardioversion; bleeding with balanced care.[3]
Postop (2). Monitored bed; ACHD review.[1]
References3ShowHide
- [1]Maxwell BG, Wong JK, Kin C, Lobato RL Perioperative outcomes of major noncardiac surgery in adults with congenital heart disease. Anesthesiology, 2013.PMID 23907357
- [2]McNamara JR, McMahon A, Griffin M Perioperative Management of the Fontan Patient for Cardiac and Noncardiac Surgery. J Cardiothorac Vasc Anesth, 2022.PMID 34023201
- [3]Baehner T, Ellerkmann RK Anesthesia in adults with congenital heart disease. Curr Opin Anaesthesiol, 2017.PMID 28306681