ペースメーカーを装着したFontan循環患児の抜歯に対する全身麻酔経験

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  • General Anesthesia for Tooth Extractions in a Child with Fontan Circulation and a Pacemaker

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<p>  Preventing an increase in pulmonary vascular resistance during the anesthetic management of patients with Fontan circulation is vital. Moreover, since cardiac output is dependent on the preload, dehydration or excessive transfusion can lead to circulatory failure. We report a case of general anesthesia for multiple tooth extractions in a 12-year-old boy with Fontan circulation who was fitted with a pacemaker. The pacemaker was programmed for dual chamber (DDD) pacing, with heart rates of 70 and 120 bpm as the lower and upper limits, respectively. Increased intrathoracic pressure associated with positive pressure ventilation increases the pulmonary vascular resistance ; hence, respiration was managed with spontaneous breathing using a laryngeal mask airway (LMA). A preoperative infusion was administered to correct dehydration. Since a reduction in systemic vascular resistance and the suppression of myocardial contraction caused by anesthetic agents are features of Fontan circulation, propofol was used in combination with ketamine, which has a sympathomimetic action. The patient’s hemodynamics remained stable during the insertion of the LMA. Anesthesia was maintained using ketamine, propofol, oxygen, and air. Patients with Fontan circulation are prone to circulatory failure caused by bradycardia and tachycardia ; hence, the patient was fitted with a pacemaker. In the present case, the airway was managed using an LMA with spontaneous breathing to avoid a reduction in preload caused by increased pulmonary vascular resistance. Thus, anesthesia was maintained with a combination of propofol and ketamine to avoid circulatory suppression caused by anesthetics, ensuring a smooth anesthetic management.</p>

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