Abstract Background Pneumoperitoneum and Trendelenburg positioning are thought to increase pulmonary vascular resistance (PVR). In Fontan circulation, increased PVR is directly related to decreased ventricular preload and can result in circulatory failure. Case presentation A 23-year-old female patient with Fontan physiology was diagnosed with left paraovarian cyst torsion and underwent laparoscopic cystectomy. SpO 2 was 70% in room air. General anesthesia was induced with remimazolam, fentanyl, and rocuronium and maintained with remimazolam and remifentanil combined with an abdominal wall block. The difference between SpO 2 and central venous oxygen saturation (ScvO 2 ) increased during the induction of anesthesia and further increased with the initiation of pneumoperitoneum and Trendelenburg positioning but recovered at the completion of the surgery. Conclusions Patients with Fontan physiology and severe hypoxemia can tolerate short-term laparoscopic surgery in the Trendelenburg position under strict management. In these patients, monitoring ScvO 2 provides important circulatory information regarding the effects of pneumoperitoneum and Trendelenburg positioning.
Okano et al. (Mon,) studied this question.