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Tanaka Y, Sumie M, Hashimoto T, Osawa S, Karashima Y, Kandabashi T, Yamaura K. Anesthetic management of pheochromocytoma and paraganglioma for patients with Fontan circulation: a case series. JA Clin Rep 2023; 9:13. [PMID: 36897467 PMCID: PMC10006357 DOI: 10.1186/s40981-023-00605-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023] Open
Abstract
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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Affiliation(s)
- Yuto Tanaka
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.,Department of Anesthesia, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Makoto Sumie
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan. .,Department of Anesthesia, St. Mary's Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan.
| | - Takuma Hashimoto
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Sayaka Osawa
- Department of Critical Care, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yuji Karashima
- Operating Rooms, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Tadashi Kandabashi
- Medical Information Center, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Ken Yamaura
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
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Anagnostopoulos A, Boegli Y, Perez M, de Buys Roessingh A, Di Bernardo S, Mauron S. Laparoscopic surgery in a child with a failing Fontan circulation. Anaesth Rep 2023; 11:e12217. [PMID: 36875790 PMCID: PMC9982724 DOI: 10.1002/anr3.12217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 03/06/2023] Open
Abstract
A child with early failure of a Fontan circulation was listed for cardiac transplantation and then developed a subhepatic abscess. Surgical drainage was deemed necessary after the failure of an attempted percutaneous procedure. Following a multidisciplinary discussion, a laparoscopic technique was chosen to optimise postoperative recovery. To our knowledge, the literature does not describe any case of laparoscopic surgery in a patient with a failing Fontan circulation. This case report highlights the physiological variations involved with this management strategy, discusses the implications and risks, and offers some recommendations.
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Affiliation(s)
- A. Anagnostopoulos
- Department of AnaesthesiologyLausanne University HospitalLausanneSwitzerland
| | - Y. Boegli
- Paediatric Anaesthesia UnitLausanne University and Lausanne University HospitalLausanneSwitzerland
| | - M. Perez
- Paediatric Intensive Care UnitLausanne University and Lausanne University HospitalLausanneSwitzerland
| | - A. de Buys Roessingh
- Department of Infant and Adolescent SurgeryLausanne University and Lausanne University HospitalLausanneSwitzerland
| | - S. Di Bernardo
- Paediatric Cardiology UnitLausanne University and Lausanne University HospitalLausanneSwitzerland
| | - S. Mauron
- Paediatric Anaesthesia UnitLausanne University and Lausanne University HospitalLausanneSwitzerland
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Hara M, Hyodo A, Kimura H, Hiraki T. Transfenestration Doppler Assessment During Laparoscopic Pheochromocytoma Resection in a Patient With Fontan Circulation. J Cardiothorac Vasc Anesth 2022; 36:3655-3661. [PMID: 35659830 DOI: 10.1053/j.jvca.2022.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Masato Hara
- Department of Anesthesiology, Kurume University School of Medicine, Fukuoka, Japan.
| | - Ayako Hyodo
- Department of Anesthesiology, Kurume University School of Medicine, Fukuoka, Japan
| | - Hiroko Kimura
- Department of Anesthesiology, Kurume University School of Medicine, Fukuoka, Japan
| | - Teruyuki Hiraki
- Department of Anesthesiology, Kurume University School of Medicine, Fukuoka, Japan
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Cummings JJ, Siegrist KK, Deegan RJ, Solórzano CC, Eagle SS. Robotic Adrenalectomy for Pheochromocytoma in a Patient with Fontan Physiology. J Cardiothorac Vasc Anesth 2020; 34:2446-2451. [PMID: 32434722 DOI: 10.1053/j.jvca.2020.02.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Jared J Cummings
- Division of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Kara K Siegrist
- Division of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Robert J Deegan
- Division of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Carmen C Solórzano
- Division of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Susan S Eagle
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
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Yokota Y, Noda T, Kobayashi S, Matsumoto K, Sakano Y, Iwagami Y, Tomimaru Y, Akita H, Gotoh K, Umeshita K, Doki Y, Eguchi H. A case report of Fontan procedure-related hepatocellular carcinoma: pure laparoscopic approach by low and stable pneumoperitoneum. BMC Surg 2020; 20:80. [PMID: 32316959 PMCID: PMC7171803 DOI: 10.1186/s12893-020-00741-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/06/2020] [Indexed: 11/17/2022] Open
Abstract
Background The Fontan procedure has become the standard operation for patients with single ventricle physiology. Due to cardiac hypokinesis and high central venous pressure, laparoscopic approach, especially in hepatectomy, was considered as controversial after the Fontan procedure. We presented a case of hepatocellular carcinoma (HCC) that was successfully treated by pure laparoscopic hepatectomy with stable pneumoperitoneum after the Fontan procedure. Case presentation An 18-year-old man was referred to our hospital for examination of a hepatic tumor. The patient underwent the Fontan procedure for single ventricle physiology at 6 years of age. Abdominal contrast-enhanced computed tomography (CT) revealed a hypovascular mass in segment 2 and a hypervascular mass in segment 4 of the arterial phase, followed by a delayed washout. CT arteriography revealed that both masses showed hypervascular tumors, and CT during arterial portography showed that both were low-density masses. The patient’s general condition was good, and cardiac and respiratory functions were well maintained. Pure laparoscopic hepatectomy was safely performed by keeping the pneumoteritoneum pressure under 6–8 mmHg and monitoring central venous pressure (11–21 mmHg) and end-tidal carbon dioxide. The Pringle maneuver was applied during hepatic resection. The non-anatomical resections were completed without intraoperative complications. The patient was discharged on the 9th postoperative day without postoperative complications. Conclusions Our report suggests that treatment of HCC by pure laparoscopic hepatectomy after Fontan circulation can be safely performed in patients under sufficient circulatory management.
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Affiliation(s)
- Yuki Yokota
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takehiro Noda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shogo Kobayashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Kenichi Matsumoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yoshihiro Sakano
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yoshifumi Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yoshito Tomimaru
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hirofumi Akita
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kunihito Gotoh
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Koji Umeshita
- Division of Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
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Suffredini G, Diaz-Rodriguez N, Chakravarthy K, Mathur A, Hayanga HK, Frank SM, Ringel RE, Freiberg S, Barodka VM, Steppan J. Anesthetic Management of Pheochromocytoma Resection in Adults with Single Ventricle Physiology. Cureus 2017; 9:e1928. [PMID: 29464136 PMCID: PMC5806932 DOI: 10.7759/cureus.1928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Survival rates for patients with palliated congenital heart disease are increasing, and an increasing number of adults with cyanotic congenital heart disease (CCHD) might require surgical resection of pheochromocytoma-paraganglioma (PHEO-PGL). A recent study supports the idea that patients with a history of CCHD and current or historical cyanosis might be at increased risk for developing PHEO-PGL. We review the anesthetic management of two adults with single-ventricle physiology following Fontan palliation presenting for PHEO-PGL resection and review prior published case reports. We found the use of epidural analgesia to be safe and effective in the operative and postoperative management of our patients.
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Affiliation(s)
- Giancarlo Suffredini
- Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine
| | | | - Krishnan Chakravarthy
- Department of Anesthesia, Critical Care and Pain Medicine, University of California, San Diego
| | - Aarti Mathur
- Surgery, The Johns Hopkins University School of Medicine
| | - Heather K Hayanga
- Department of Anesthesiology, West Virginia University School of Medicine
| | - Steve M Frank
- Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine
| | | | - Stephen Freiberg
- Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine
| | - Viachaslau M Barodka
- Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine
| | - Jochen Steppan
- Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine
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