フォンタン手術後の肝切除術の麻酔経験

Anesthetic Management of Hepatectomy in a Patient with Fontan Physiology

要旨

　フォンタン手術後患者の肝細胞がんに対して肝切除術を施行した症例を経験した。フォンタン循環において心拍出量を保つため肺血管抵抗を下げる管理を行い，プリングル法や出血に伴う前負荷低下に注意が必要である。

　Background：We report a patient with Fontan physiology who underwent partial hepatectomy for hepatocellular carcinoma.

　Method：In order to maintain cardiac output in Fontan circulation, we made an effort to lower pulmonary vascular resistance, maintain cardiac contractility and preload as well as, keeping blood pressure and urine output. Despite decreasing preload by the Pringle maneuver and bleeding during the hepatectomy, this patient’s Fontan circulation did not collapse. We consider that CVP measurement is useful for monitoring hemodynamics in patients with Fontan physiology.