Key result
CVP-guided anesthesia with nitric oxide and vasopressors maintains hemodynamics during tumor resection in Fontan patients.
Why the study?
Anesthetic management of pheochromocytoma and paraganglioma in patients with Fontan circulation is challenging, requiring close attention to cardiovascular physiology.
Case Report (n=3)
No
Sophisticated anesthetic management, including careful control of central venous pressure and use of vasopressin, is feasible for patients with Fontan circulation undergoing resection of pheochromocytoma or paraganglioma.
Answers are grounded in this paper and cite their sources.
May guide anesthetic planning in rare Fontan-pheochromocytoma cases; leaves open generalizability and safety in larger cohorts.
BACKGROUND: Anesthetic management of pheochromocytoma and paraganglioma with Fontan circulation is challenging for physicians, with attention to cardiovascular physiology. CASE PRESENTATION: We performed anesthetic management for pheochromocytoma and paraganglioma in three patients with Fontan circulation. We maintained intraoperative central venous pressure at preoperative level under fluid infusion and administrating nitric oxide to decrease pulmonary arterial resistance. We administered noradrenaline or vasopressin if low blood pressure was present despite adequate central venous pressure. Although noradrenaline is prevalent for the case of noradrenaline-secreting tumor especially after resection, we could maintain blood pressure to administrate vasopressin without increasing central venous pressure. Retroperitoneal laparoscopic approach which could avoid intra-abdominal adhesions might be selectable as case 3. CONCLUSIONS: Sophisticated management is required for pheochromocytoma and paraganglioma with Fontan circulation.
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Tanaka et al. (2023) conducted a case report in Pheochromocytoma and paraganglioma with Fontan circulation (n=3). Anesthetic management (fluid infusion, nitric oxide, vasopressin/noradrenaline) was evaluated. Sophisticated anesthetic management, including maintaining central venous pressure, administering nitric oxide, and using vasopressin or noradrenaline, successfully maintained hemodynamics during tumor resection in patients with Fontan circulation.
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