Perioperative anaesthetic management of a patient with single ventricle undergoing mastoidectomy

Abstract

Patients with single ventricles undergoing non-cardiac surgery have a higher incidence of perioperative complications. Factors associated  with the most significant risk are the complexity of cardiac disease and the patient’s physiological status. We here describe  the anaesthetic management and pathophysiological considerations of an 18-year-old male with a single ventricle undergoing elective  mastoidectomy. Comprehensive and multidisciplinary perioperative care is mandatory for optimal management. The patient had a history of previous cardiac surgeries for his cardiac condition and presented for elective mastoidectomy due to chronic suppurative otitis  media. Preoperative assessment revealed a satisfactory general condition with peripheral oxygen saturation (Spo2) of 90-92% on room  air. Cardiovascular evaluation showed weak S1 and S2 heart sounds and a faint systolic murmur heard best at the left upper sternal  border. Echocardiography indicated a common ventricle with a small left atrium and significant tricuspid regurgitation. Long term  medications included carbamazepine, warfarin, and aspirin. Comprehensive perioperative care, including meticulous preoperative  assessment, tailored intraoperative management, and appropriate postoperative monitoring is crucial for patients with single ventricles  undergoing non-cardiac surgery. Specialized centres equipped to manage high-risk cases are recommended to optimize outcomes and  minimize complications.