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KMID : 0356920140660030252
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Korean Journal of Anesthesiology
2014 Volume.66 No. 3 p.252 ~ p.255
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Anesthetic management of laparoscopic pheochromocytoma excision in a patient with a Fontan circulation: a case report
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Lee Hyung-Chul
Lee Ji-Hyun
Nam Ka-Ram
Park Yong-Hee
Kim Hee-Soo
Kim Chong-Sung
Kim Jin-Tae
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Abstract
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An 18-year-old male with a Fontan circulation underwent excision of a pheochromocytoma after conversion from laparoscopic surgery. The pneumoperitoneum established for laparoscopic surgery may have adverse effects on the Fontan circulation, because it increases the intra-abdominal pressure (IAP), intra-thoracic pressure, pulmonary vascular resistance, and systemic vascular resistance (SVR), and decreases cardiac preload and cardiac output. Meticulous monitoring is also required during carbon dioxide exsufflation, because a rapid decrease in IAP can provoke hemodynamic deterioration by decreasing venous return and SVR. Furthermore, catecholamines released by the pheochromocytoma can worsen the hemodynamic status of Fontan circulation during surgery. Therefore, sophisticated intraoperative anesthetic care is required during laparoscopic pheochromocytoma excision in patients with a Fontan circulation.
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KEYWORD
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Fontan procedure, General anesthesia, Laparoscopic surgery, Pheochromocytoma
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