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Perioperative management of Fontan operation for the child with panhypopituitarism: a case report

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Abstract

With the surgical improvement of congenital heart disease, Fontan operation has been applied to many complicated patients in recent years. This is the first report of a child with panhypopituitarism who underwent Fontan operation. A 5-year-old boy was scheduled for Fontan operation. He previously underwent Blalock-Taussig shunt and bidirectional Glenn operations for univentricular heart with double-outlet right ventricle and pulmonary atresia. He was receiving hydrocortisone and 1-desamino-8-D-arginine vasopressin (DDAVP) for panhypopituitarism secondary to removal of craniopharyngioma performed at the age of three years. Although urine output and serum sodium concentration were adequately controlled by adjustment of vasopressin infusion rate during surgery, massive pleural effusions and ascites developed postoperatively, which required several days for control by adjusting the dose of oral DDAVP and normalize the serum sodium level. Intraoperative management of Fontan operation for a patient with panhypopituitarism was controllable by appropriate hormone replacement. However, postoperative fluid management was complicated by the clinical features of panhypopituitarism and Fontan physiology.

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Authors and Affiliations

  1. Department of Pediatric Intensive Care and Anesthesia, Jichi Children’s Medical Center Tochigi, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan

    Kohei Sunoki, Yoji Otsuka, Hidetaka Iwai, Tatsuya Nagano, Naoyuki Taga & Mamoru Takeuchi

  2. Department of Pediatric and Congenital Cardiovascular Surgery, Jichi Children’s Medical Center Tochigi, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan

    Masaaki Kawada

  3. Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan

    Mamoru Takeuchi

Authors
  1. Kohei Sunoki
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  2. Yoji Otsuka
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  3. Hidetaka Iwai
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  4. Tatsuya Nagano
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  5. Naoyuki Taga
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  6. Masaaki Kawada
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  7. Mamoru Takeuchi
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Correspondence to Kohei Sunoki.

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Sunoki, K., Otsuka, Y., Iwai, H. et al. Perioperative management of Fontan operation for the child with panhypopituitarism: a case report. J Anesth 35, 303–306 (2021). https://doi.org/10.1007/s00540-020-02894-5

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  • DOI: https://doi.org/10.1007/s00540-020-02894-5

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