Hostname: page-component-76fb5796d-5g6vh Total loading time: 0 Render date: 2024-04-25T17:26:42.206Z Has data issue: false hasContentIssue false
  • English
  • Français

Anaesthesia for non-cardiac surgery in children and young adults with Fontan physiology

Published online by Cambridge University Press:  04 November 2022

Morgan L. Brown Open the ORCID record for Morgan L. Brown [Opens in a new window] ,
Michael Cradeur ,
Steven J. Staffa ,
Viviane G. Nasr Open the ORCID record for Viviane G. Nasr [Opens in a new window] ,
Michael R. Hernandez  and
James A. DiNardo
Morgan L. Brown*
Affiliation:
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
Michael Cradeur
Affiliation:
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
Steven J. Staffa
Affiliation:
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
Viviane G. Nasr
Affiliation:
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
Michael R. Hernandez
Affiliation:
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
James A. DiNardo
Affiliation:
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
*
Author for correspondence: Morgan L Brown MD, PhD, Department of Anesthesiology, Critical Care, and Pain Medicine, 300 Longwood Ave, Boston, MA 02446, USA. Email: morgan.brown@childrens.harvard.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Patients with Fontan physiology require non-cardiac surgery. Our objectives were to characterise perioperative outcomes of patients with Fontan physiology undergoing non-cardiac surgery and to identify characteristics which predict discharge on the same day.

Materials and Method:

Children and young adults with Fontan physiology who underwent a non-cardiac surgery or an imaging study under anaesthesia between 2013 and 2019 at a single-centre academic children’s hospital were reviewed in a retrospective observational study. Continuous variables were compared using the Wilcoxon rank sum test, and categorical variables were analysed using the Chi-square test or Fisher’s exact test. Multivariable logistic regression analysis results are presented by adjusted odds ratios with 95% confidence intervals and p values.

Results:

182 patients underwent 344 non-cardiac procedures with anaesthesia. The median age was 11 years (IQR 5.2–18), 56.4% were male. General anaesthesia was administered in 289 (84%). 125 patients (36.3%) were discharged on the same day. On multivariable analysis, independent predictors that reduced the odds of same-day discharge included the chronic condition index (OR 0.91 per additional chronic condition, 95% CI 0.76–0.98, p = 0.022), undergoing a major surgical procedure (OR 0.17, 95% CI 0.05–0.64, p = 0.009), the use of intraoperative inotropes (OR 0.48, 95% CI 0.25–0.94, p = 0.031), and preoperative admission (OR = 0.24, 95% CI: 0.1–0.57, p = 0.001).

Discussion:

In a contemporary cohort of paediatric and young adults with Fontan physiology, 36.3% were able to be discharged on the same day of their non-cardiac procedure. Well selected patients with Fontan physiology can undergo anaesthesia without complications and be discharged same day.

Keywords

CHDnoncardiac surgeryanaesthesiaFontan
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 10 , October 2023 , pp. 1896 - 1901
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Gewillig, M, Brown, SC. The Fontan circulation after 45 years: update in physiology. Heart 2016; 102: 1081–1086.CrossRefGoogle ScholarPubMed
Yuki, K, Al, Casta, Uezono, S. Anesthetic management of noncardiac surgery for patients with single ventricle physiology. J Anesth 2011; 25: 247–256.CrossRefGoogle ScholarPubMed
Jolley, M, Colan, SD, Rhodes, J, DiNardo, J. Fontan physiology revisited. Anesth Analg 2015; 121: 172–182.10.1213/ANE.0000000000000717CrossRefGoogle ScholarPubMed
Atz, AM, Zak, V, Mahony, et al. Survival data and predictors of functional outcome an average of 15 years after the Fontan procedure: the Pediatric Heart Network Fontan Cohort. Congenit Heart Dis 2015; 10: E30–42.CrossRefGoogle ScholarPubMed
Ono, M, Boethig, D, Goerler, H, et al. Clinical outcome of patients 20 years after Fontan operation-effect of fenestration on late morbidity. Eur J Cardiothorac Surg 2006; 30: 923–929.CrossRefGoogle ScholarPubMed
Reddy, S, Siehr Handler, S, Wu, S, Rabinovitch, M, Wright, G. Proceedings from the 2019 Stanford single ventricle scientific summit: advancing science for single ventricle patients: from discovery to clinical applications. JAHA 2020; 9: e015871.10.1161/JAHA.119.015871CrossRefGoogle ScholarPubMed
Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project. User guide: chronic condition indicator for ICD-10-CM, v2021.1 (Beta version) 2020. Accessed May 24, 2021. Available at: https://www.hcup-us.ahrq.gov/toolssoftware/chronic_icd10/chronic_icd10.jsp.Google Scholar
Rabbitts, JA, Groenewald, CB, Mauermann, WJ, et al. Outcomes of general anesthesia for noncardiac surgery in a series of patients with fontan palliation. Pediatr Anaesth. 2013; 23: 180–187.10.1111/pan.12020CrossRefGoogle Scholar
Egbe, AC, Khan, AR, Ammash, NM, et al. Predictors of procedural complications in adult Fontan patients undergoing non-cardiac procedures. Heart. 2017; 103: 1813–1820.CrossRefGoogle ScholarPubMed
Uehara, M, Takahashi, J, Akazawa, Y, et al. Posterior spinal fusion for scoliosis after Fontan procedure. J Orthoped Sci. 2018; 23: 294–298.10.1016/j.jos.2017.11.004CrossRefGoogle ScholarPubMed
Przybylski, R, Hedequist, DJ, Nasr, VG, et al. Adverse perioperative events in children with complex congenital heart disease undergoing operative scoliosis repair in the contemporary era. Pediatr Cardiol. 2019; 40: 1468–1475.10.1007/s00246-019-02169-1CrossRefGoogle ScholarPubMed
Bundts, W, Ravekes, WJ, Danford, DA, Kutty, S. Diastolic heart failure in patients with the Fontan circulation: a review. JAMA Cardiol. 2020; 5: 590–597.CrossRefGoogle Scholar
D’Udekem, Y, Iyengar, AJ, Cochrane, AD, et al. Contemporary techniques have improved long-term outcomes. Circulation 2007; 116: I157–I164.CrossRefGoogle ScholarPubMed