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2 results

  • Chapter 26 - Stage I Palliation, Hypoplastic Left Heart Syndrome

  • from Section 5 - Single-Ventricle Physiology
  • Edited by Laura K. Berenstain, James P. Spaeth
  • Book:
    Congenital Cardiac Anesthesia
    Published online:
    09 September 2021
    Print publication:
    16 September 2021, pp 187-197

  • Summary

    Noncardiac surgery in patients with hypoplastic left heart syndrome (HLHS) and other variants of single-ventricle physiology presents unique risks, especially prior to and after the first stage of surgical palliation. Although there are a number of cardiac defects that may be treated with single-ventricle palliation, there are principles that may be generalized for the perioperative care of these patients. Preoperative assessment of their status and knowledge of their pathophysiology may aid the anesthesiologist in mitigating these risks. Laparoscopy remains controversial in this population, as patients with single-ventricle physiology may be ill equipped to tolerate the physiologic derangements that laparoscopy induces. This chapter presents an overview of single-ventricle physiology including bedside clinical assessment, as well as the expected physiologic changes associated with laparoscopy. It then reviews the published outcomes of laparoscopic versus open Nissen fundoplication. Finally, it reviews specific and devastating perioperative complications that may occur in patients with stage I palliation.

  • Transient left vocal cord paralysis during laparoscopic surgery for an oesophageal hiatus hernia

  • A. Kanski, E. Plocharska, E. Stanowski, T. Koziarski, A. Chmurzynska
  • Journal:
    European Journal of Anaesthesiology / Volume 16 / Issue 7 / July 1999
    Published online by Cambridge University Press:
    16 August 2006, pp. 495-499
    Print publication:
    July 1999

  • A 45-year-old male, with symptoms of many years standing of gastro-oesophageal reflux disease, was subjected, under general anaesthesia, to laparoscopic fundoplication.Tracheal intubation yielded no problems but great difficulties were encountered during tube insertion into the oesophagus. After surgery, aphonia developed. Laryngological examination demonstrated paralysis of the left vocal cord. Voice strength returned to the pre-operative status after 3 months, and laryngological examination confirmed normal mobility of both cords. The possible cause of the complication was damage to the left recurrent laryngeal nerve which occurred during insertion of the tube into the oesophagus. Gastro-oesophageal reflux disease causing ‘acid laryngitis’ can create conditions favouring this type of complication.