Tachibana K, Uchida O, Shimizu J, Kuro M
Department of Anesthesiology, National Cardiovascular Center, Osaka.
Masui. 1998 Aug;47(8):972-7.
We examined the anesthetic management for Fontan procedure performed without the use of cardiopulmonary bypass (Group N, n = 7) and that for equivalent procedure under cardiopulmonary bypass (Group E, n = 10) retrospectively. In Group N, surgical repairs of major vascular system were performed while bypassing the superior or inferior vena cava to the right atrium. The use of anesthetics and vasoactive agents was similar in both groups. Patients in Group N had significantly less blood loss and were extubated significantly earlier than those in Group E. However, significant metabolic acidosis was noted in Group N when reconstruction of the vascular system was completed and so-called Fontan circulation was initiated. Fontan procedure without the use of cardiopulmonary bypass may have advantage of less impairment for the cardiac performance and the pulmonary vasculature. However, its anesthetic management is another challenge to the anesthesiologist and requires meticulous control of both optimum preload and vascular resistance of the pulmonary artery.
我们回顾性研究了在非体外循环下进行Fontan手术的麻醉管理（N组，n = 7）以及在体外循环下进行同等手术的麻醉管理（E组，n = 10）。在N组中，主要血管系统的手术修复是在将上腔静脉或下腔静脉绕过至右心房的情况下进行的。两组麻醉药和血管活性药物的使用情况相似。N组患者的失血量明显少于E组，且拔管时间明显早于E组。然而，在N组中，当血管系统重建完成并启动所谓的Fontan循环时，出现了明显的代谢性酸中毒。非体外循环下的Fontan手术可能具有对心脏功能和肺血管系统损伤较小的优势。然而，其麻醉管理对麻醉医生来说是另一项挑战，需要精确控制肺动脉的最佳前负荷和血管阻力。
