Anesthesia Management in a Case with Hypoplastic Left Heart Syndrome

Saglık Bilimleri Universitesi 1. Uluslararasi Anesteziyoloji ve Reanimasyon Sempozyumu, İstanbul, Türkiye, 3 - 04 Aralık 2021, ss.259

INTRODUCTION - PURPOSE: Hypoplastic Left Heart Syndrome (HSCS) is a congenital heart

lesion that is almost fatal if left untreated. We aimed to present the anesthesia management of a

HSCS case operated under general anesthesia due to multiple dental caries in our clinic, in the

light of the literature.

CASE: 6 years old, 17 kg patient had 3 serial open heart operations (atrial septectomy and

pulmonary banding) when she was 1 month old. Preoperative consultations were requested for the

patient with transposed type double outlet right ventricle, high sinus venosus type ASD. Infective

endocarditis prophylaxis was performed. After obtaining written consent from the family, standard

anesthesia monitoring was performed. Peripheral SO2:83, BP:120/70 mmHg, pulse: 110-120

beats/min. sinus rhythm in room air. After preoxygenation with 4 lt/min O2 for 2 minutes, the

patient was administered 1mg midazolam, 10mg ketamine, followed by 10mcg fentanyl and 8mg

rocuronium, and was nasally intubated with a 5.0 spiral tube. Anesthesia was maintained with 0.8

mac sevoflurane, 3 lt/min fresh gas (80% O2, 20% medical air) and the patient's intraoperative

peripheral SO2 values ranged between 85-88. Local anesthetic was administered by the surgeon

before and at the end of the surgery. In addition, 200 mg of paracetamol was administered. In the

patient who was extubated under deep anesthesia, 40 mg of suggammadex was administered to

the patient simultaneously with the closure of sevoflurane. The spontaneously breathing patient

was taken to the recovery unit. In the follow-up, the patient with GCS 15, conscious oriented,

cooperative, o2 unsupported so2 84 was sent to the service.

DISCUSSION - CONCLUSION: Adequate oxygenation/ventilation and pain control should be

provided to prevent pulmonary hypertension as well as maintaining adequate preload in the

anesthesia management of patients with congenital heart diseases such as HSCS. Postoperative

dehydration and reduced preload should be avoided.