Key result
TIVA with propofol and fentanyl enables hemodynamically stable scoliosis surgery without pressors or paralysis.
Why the study?
In children with Fontan circulation and single-ventricle physiology, anesthesia for thoracic deformity correction is complex due to potential compromise of transpulmonary flow and cardiac output, and literature on anesthesia care for scoliosis correction in these patients is sparse.
Case Report (n=1)
No
Demonstrates that total intravenous anesthesia with propofol and fentanyl without paralysis, combined with ventilatory strategies preserving transpulmonary blood flow, can safely support scoliosis correction in an adolescent with nonfenestrated Fontan physiology.
Answers are grounded in this paper and cite their sources.
Supports TIVA without paralysis in Fontan scoliosis correction; hypothesis-generating and requires prospective validation before adoption.
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.
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Emad Lafi Alotibi (2026) conducted a case report in Adolescent idiopathic scoliosis with Fontan circulation secondary to hypoplastic left heart syndrome (HLHS) (n=1). Total intravenous anesthesia with propofol and fentanyl without paralysis was evaluated on Intraoperative hemodynamic stability, pressor support requirement, and extubation status. Total intravenous anesthesia with propofol and fentanyl enabled a 4-hour bloodless, hemodynamically stable scoliosis correction without pressor support or paralysis.
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