Anesthetic management of a single ventricle pediatric patient with a major burn injury, case report

Background: Glenn procedure is a Palliative surgical procedure performed as a step of staged repair for patients with single ventricle such as tricuspid atresia and hypoplastic left heart syndrome. It is usually performed at about three to six months of age, directs systemic venous blood directly from the superior vena cava to the pulmonary circulation. A significant burn injury affects almost all organs. Understanding the complex and pathophysiological responses in the early and late phases of injury is imperative to provide care in the acute and perioperative period. Large airway and lung edema can occur rapidly and unpredictably after burn. Hemodynamics changes in the early phase of severe burn injury are characterized by a reduction in cardiac output and increased systemic and pulmonary vascular resistance. Case Summary: We report the management of a single ventricle patient with its challenges and unique consideration and major burn with its problems. She underwent serial debridement, extensive skin grafting to all burn areas. The patient had hemoglobin of 8.7 g/dl, she was on dopamine infusion to maintain blood pressure which was difficult to measure by BP cuff, the extremities were not an option to use as monitoring sites. Upon arrival, her oxygen saturation (SpO2) was being monitored with a disposable pulse oximetry sensor through the ear lobule, at times monitoring was disrupted and disappeared. We managed to use an oral airway to measure oxygen saturation through soft palate successfully and after transfusion we could wean off inotropic support. Conclusion: Patients with Glenn shunt whose acceptable oxygen saturation is 75-80% need hemoglobin level above 13 g/dl. Measurements of capillary density using reflectance oximetry through the soft palate provide very reliable SpO2 measurements.