We are finding advices on "operability" and diagnostic tests of tolerance of a 12 Kgs patient affected with genito-urinary complex lesion and single ventricle s/p intestinal stoma, s/p well functioning bi-Glenn procedure with the need of stay on the operating table of the pediatric surgeon for genitor-urinary surgical procedure in deep Trendelemburg position for several hours
The pulmonary flow (non pulsatile) post Glenn depends on gravity for flow--that is the premsie of the question. If the patient is long enough , you could put the child in a Fowler's with legs raised or Trendelenberg with head raised...the venous return from SVC is sufficient to keep the flow through Glenn patent ! and one may (re)position the child every two hourly or so in between the surgery and then continue with the pelvic surgery. the other option would be to run iv fluids (hanging above the Centre of Gravity of the Glenn Flow) through the central line . Moreover, if IVC flow is also routed into Glenn in BCPC , then trendelenberg position would not affect the shunt flow...it would be then the SVC return which would pool in the face / UL . You could do a trial run of the positions in the ICU for couple of hours and check Central venous O2 and serial lactate levels to assess the feasibility and also do an ECHO if possible to assess the shunt hemodynamics
