[Anesthetic management for laparoscopic Nissen fundoplication in a 18 trisomy patient with congestive heart disease].

A 21-month-old patient diagnosed as 18 trisomy, having large ventricular septal defect with pulmonary valve stenosis, and gastroesophageal reflux disease, was admitted for laparoscopic Nissen fundoplication and gastrostomy. Anesthesia was induced with midazolam, fentanyl, and rocuronium, and maintained with sevoflurane and remifentanil. After induction of anesthesia, oxygenation became worse, possibly due to diminished pulmonary blood flow, which was partially resolved with vasopressor administration and fluid infusion. After the abdomen was insufflated, oxygenation improved significantly. We supposed that an increase in systemic vascular resistance due to O2 insufflation augmented pulmonary blood flow and improved the oxygenation. She was extubated the next day and recovered uneventfully. However, we should bear in mind that 18 trisomy patients are frequently complicated by congestive heart disease, and require caution for hemodynamic changes during anesthesia.