General anesthesia during dental treatment in a pediatric patient with Fontan circulation using a minimally invasive cardiac output monitoring device

This case report presents the hemodynamic management of a 3-year-old patient with Fontan circulation who underwent dental treatment under general anesthesia using minimally invasive cardiac output monitoring devices. To avoid the use of monitoring methods more invasive than the dental procedure itself, cardiac output was continuously assessed using FloTrac™ and BioZ.com™ systems. The bispectral index was maintained between 40 and 67 during anesthesia. Although the patient's body surface area (BSA) was 0.5 m2, which is below the validated threshold for both devices, monitoring was cautiously conducted to observe hemodynamic trends. Discrepancies in the cardiac output and index values were observed between the two modalities. Although the absolute values were less reliable owing to the patient's low BSA, hemodynamic stability was maintained by tracking the dynamic changes in cardiac parameters. These observations underscore both the limitations and the potential of noninvasive cardiac monitoring in pediatric patients with Fontan circulation undergoing general anesthesia. Accordingly, future development of monitoring technologies that can accurately measure cardiac output in pediatric patients with BSA < 1 m2 is warranted.