Papers of the Week

The bidirectional (BD) Glenn shunt or hemi-Fontan procedure has been used to temporarily improve cardiac function in patients with severe structural heart disease which feature single ventricular physiology. Subsequently, more of these patients present for noncardiac surgical interventions, which present as an anaesthetic challenge. Erector spinae block (ESP) is an effective analgesic modality used in various thoraco abdominal surgeries, which can also be given safely in such patients. A case of a 17-year-old female patient with complex congenital heart disease (CHD) who underwent BD Glenn shunting with main pulmonary artery ligation in childhood, presently admitted for laparoscopic cholecystectomy done under general anaesthesia. With detailed preoperative workups, close haemodynamic monitoring and use of ESP for analgesia during perioperative period, the patient had successful outcome. We outline the anaesthetic management and the concerns of laparoscopy in such patients. A comprehensive understanding of physiology of Glenn's shunt and implications of the proposed surgical procedure is necessary to plan the anaesthetic and analgesic agents, cardiovascular drugs and ventilation strategies in patients with CHD with shunt procedure done.