{"title":"伴有Fontan生理和严重低氧血症的患者在Trendelenburg位腹腔镜手术的麻醉管理:1例报告。","authors":"Shunsuke Okano, Masahiro Kuroki, Shun Abe, Yu Matsuura, Ayuka Narisawa, Hiroaki Toyama","doi":"10.1186/s40981-025-00820-w","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Case presentation: </strong>A 23-year-old female patient with Fontan physiology was diagnosed with left paraovarian cyst torsion and underwent laparoscopic cystectomy. SpO<sub>2</sub> 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<sub>2</sub> and central venous oxygen saturation (ScvO<sub>2</sub>) 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.</p><p><strong>Conclusions: </strong>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<sub>2</sub> provides important circulatory information regarding the effects of pneumoperitoneum and Trendelenburg positioning.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"53"},"PeriodicalIF":1.0000,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12480132/pdf/","citationCount":"0","resultStr":"{\"title\":\"Anesthesia management for laparoscopic surgery in the Trendelenburg position in a patient with Fontan physiology and severe hypoxemia: a case report.\",\"authors\":\"Shunsuke Okano, Masahiro Kuroki, Shun Abe, Yu Matsuura, Ayuka Narisawa, Hiroaki Toyama\",\"doi\":\"10.1186/s40981-025-00820-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Case presentation: </strong>A 23-year-old female patient with Fontan physiology was diagnosed with left paraovarian cyst torsion and underwent laparoscopic cystectomy. SpO<sub>2</sub> 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<sub>2</sub> and central venous oxygen saturation (ScvO<sub>2</sub>) 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.</p><p><strong>Conclusions: </strong>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<sub>2</sub> provides important circulatory information regarding the effects of pneumoperitoneum and Trendelenburg positioning.</p>\",\"PeriodicalId\":14635,\"journal\":{\"name\":\"JA Clinical Reports\",\"volume\":\"11 1\",\"pages\":\"53\"},\"PeriodicalIF\":1.0000,\"publicationDate\":\"2025-09-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12480132/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JA Clinical Reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1186/s40981-025-00820-w\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JA Clinical Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s40981-025-00820-w","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Anesthesia management for laparoscopic surgery in the Trendelenburg position in a patient with Fontan physiology and severe hypoxemia: a case report.
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. SpO2 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 SpO2 and central venous oxygen saturation (ScvO2) 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 ScvO2 provides important circulatory information regarding the effects of pneumoperitoneum and Trendelenburg positioning.
期刊介绍:
JA Clinical Reports is a companion journal to the Journal of Anesthesia (JA), the official journal of the Japanese Society of Anesthesiologists (JSA). This journal is an open access, peer-reviewed, online journal related to clinical anesthesia practices such as anesthesia management, pain management and intensive care. Case reports are very important articles from the viewpoint of education and the cultivation of scientific thinking in the field of anesthesia. However, submissions of anesthesia research and clinical reports from Japan are notably decreasing in major anesthesia journals. Therefore, the JSA has decided to launch a new journal, JA Clinical Reports, to encourage JSA members, particularly junior Japanese anesthesiologists, to publish papers in English language.