Anaesthetic Management in a Patient with Fontan Circulation Posted for Elective Tibial Nailing

Abstract

The fatality rate for pediatric population with complex congenital cardiac disease has decreased as a result of improvements in surgical techniques and conservative management ^[1]. Therefore, more patients are presenting for non-cardiac surgeries as adults with congenital cardiac history ^[2]. For individuals with complex congenital cardiac disease and single ventricle physiology, the fontan procedure is a palliative operation that reroutes the systemic venous return to the pulmonary artery ^[3].  Despite improvements in outcomes, this aberrant circulation has a number of co-morbidities, including cardiac dysfunction, arrhythmias, shunt abnormalities, limited exercise ability, and other systemic manifestations ^[4]. These patients raise various anaesthetic concerns, such as understanding underlying cardiac morphology and mechanics and being conversant with the complexities of fontan physiology for efficient intra-operative management. In this report, we present a case of a 17-year-old male, with complex congenital heart disease with fontan physiology, posted electively for left tibia nailing under sequential combined spinal epidural anaesthesia.