Journal of The Korean Dental Society of Anesthesiology (대한치과마취과학회지)

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
권호 표지

Deep Sedation for Palate Alginate Impression Procedure in a Post-Fontan Procedure Patient with Mental Retardation

Fontan 수술을 받은 정신지체 소아에서 인상채득을 위해 시행한 깊은 진정

  • Lee, Jung-Man (Department of Dental Anesthesiology, Seoul National University Dental Hospital) ;
  • Seo, Kwang-Suk (Department of Dental Anesthesiology, Seoul National University Dental Hospital) ;
  • Kim, Hyun-Jeong (Department of Dental Anesthesiology, Seoul National University Dental Hospital) ;
  • Shin, Soon-Young (Department of Dental Anesthesiology, Seoul National University Dental Hospital) ;
  • Shin, Teo-Jeon (Department of Pediatric Dentistry, Seoul National University Dental Hospital)
  • 이정만 (서울대학교치과병원 치과마취과) ;
  • 서광석 (서울대학교치과병원 치과마취과) ;
  • 김현정 (서울대학교치과병원 치과마취과) ;
  • 신순영 (서울대학교치과병원 치과마취과) ;
  • 신터전 (서울대학교치과병원 소아치과)
  • Received : 2012.03.30
  • Accepted : 2012.04.03
  • Published : 2012.03.30
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Abstract

The Fontan operation is a heart operation used to treat complex congenital heart defects like tricuspid atresia, hypoplastic left heart syndrome, pulmonary atresia and single ventricle. A single ventricle is dedicated to pumping oxygenated blood to the systemic circulation and the entire systemic venous return reaches the pulmonary arterial system without the direct influence of a pumping chamber. In the patient with Fontan operation, it is important to achieve adequate pulmonary blood flow and cardiac output in anesthetic management. In this case, a 10-year-old boy (19.6 kg, 114 cm) with cleft palate, cerebral palsy and severe mental retardation, who underwent a Fontan operation when he was 4 years old, was presented for deep sedation. Because he was suffering from eating disorder with cleft palate, the orthodontist and the plastic surgeon planned to insert intraoral orthodontic device before cleft palate repair. But it was impossible to open his mouth for alginate impression procedure. After careful pre-anesthesia evaluation we planned to administer deep sedation with propofol infusion. After Intravenous catheter insertion, we started propofol intravenous infusion with the formula of a loading dose of 1.0 mg/kg followed by an infusion rate of 6.0 mg/kg/hr with syringe pump. His blood pressure was remained around 80/40 mmHg after loss of consciousness, but he could not maintain his airway patent. So we lowered the infusion rate to 3.0 mg/kg/hr, immediately. The oxygen saturation was maintained above 95% with nasal oxygen supply, and blood pressure was maintained around 100-80/60-40 mmHg. After the sedation of 110 minutes with propofol (the infusion rate to 3.0-5.0 mg/kg/hr), he fully regained consciousness, and was discharged without complication after 1 hour observation. In case of post-Fontan patient, intravenous deep sedation with propofol was safe and effective method of behavioral management during dental treatment.

Keywords

References

  1. Heggie J, Poirer N, Williams WG, Karski J: anesthetic considerations for adult cardiac surgery patients with congenital heart disease. Semin Cardiothorac Vasc Anesth 2003; 7(2): 141-52. https://doi.org/10.1177/108925320300700203
  2. Tokuhira N, Atagi K, Shimaoka H, Ujiro A, Otsuka Y, Ramsay M: Dexmedetomidine sedation for pediatric post-Fontan procedure patients. Pediatr Crit Care Med 2009; 10(2): 207-12. https://doi.org/10.1097/PCC.0b013e31819a3a3e
  3. Marcelletti CF, Iorio FS, Abella RF: Late results of extracardiac Fontan repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 1999; 2: 131-42. https://doi.org/10.1016/S1092-9126(99)70014-1
  4. Burkhart HM, Dearani JA, Mair DD, Warnes CA, Rowland CC, Schaff HV, et al: The modified Fontan procedure: early and late results in 132 adult patients. J Thorac Cardiovasc Surg 2003; 125(6): 1252-9. https://doi.org/10.1016/S0022-5223(03)00117-X
  5. Kim SJ, Kim WH, Lim HG, Lee JY: Outcome of 200 patients after an extracardiac Fontan procedure. J Thorac Cardiovasc Surg 2008; 136(1): 108-16. https://doi.org/10.1016/j.jtcvs.2007.12.032
  6. Shirai LK, Rosenthal DN, Reitz BA, Robbins RC, Dubin AM: Arrhythmias and thromboembolic complications after the extracardiac Fontan operation. J Thorac Cardiovasc Surg 1998; 115(3): 499-505. https://doi.org/10.1016/S0022-5223(98)70311-3
  7. Humes RA, Feldt RH, Porter CJ, Julsrud PR, Puga FJ, Danielson GK: The modified Fontan operation for asplenia and polysplenia syndromes. J Thorac Cardiovasc Surg 1988; 96(2): 212-8.
  8. Kirklin JK, Blackstone EH, Kirklin JW, Pacifico AD, Bargeron LM, Jr: The Fontan operation. Ventricular hypertrophy, age, and date of operation as risk factors. J Thorac Cardiovasc Surg 1986; 92(6): 1049-64.
  9. Hosking MP, Beynen FM: The modified Fontan procedure: physiology and anesthetic implications. J Cardiothorac Vasc Anesth 1992; 6(4): 465-75. https://doi.org/10.1016/1053-0770(92)90017-2
  10. Mclean RF, Prielipp RC, Rosenthal MH, Pearl RG: Vasodilator therapy in microembolic porcine pulmonary hypertension. Anesth Analg 1990; 71(1): 35-41.
  11. Ichinose F, Roberts JD, Jr, Zapol WM: Inhaled nitric oxide: a selective pulmonary vasodilator: current uses and therapeutic potential. Circulation 2004; 109(25): 3106-11. https://doi.org/10.1161/01.CIR.0000134595.80170.62
  12. Cromme-Dijkhuis AH, Hess J, Hahlen K, Henkens CM, Bink-Boelkens MT, Eygelaar AA, et al: Specific sequelae after Fontan operation at mid-and long-term follow-up. Arrhythmia, liver dysfunction, and coagulation disorders. J Thorac Cardiovasc Surg 1993; 106(6): 1126-32.
  13. Webb GD, Harrison DA, Connelly MS: Challenges posed by the adult patient with congenital heart disease. Adv Intern Med 1996; 41: 437-95.
  14. 서광석, 신터전, 김현정, 한희정, 한진희, 김혜정, et al: 치과적 장애환자의 치과치료를 위해 시행한 깊은 진정: 전신마취와 비교한 통계적 고찰. 대한장애인치과학회지 2009; 5: 12-7.
  15. Cravero JP, Beach ML, Blike GT, Gallagher SM, Hertzog JH: The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium. Anesth Analg 2009; 108(3): 795-804. https://doi.org/10.1213/ane.0b013e31818fc334
  16. Mcfarlan CS, Anderson BJ, Short TG: The use of propofol infusions in paediatric anaesthesia: a practical guide. Paediatric Anaesthesia 1999; 9: 209-16.