PMC8710755_01
(A) The patient presented with left complete cleft lip and palate. Hypotonia and macroglossia were not observed, which may be related to regular ERT beginning at 15 days old. (B) Electrical Cardiometry Technology (ICON ) calculated and provided instant SV, SI, SVR, CO, ICON, and CI during the operation. (C) ICON  sensors were located at the left side of the neck and thorax. Arrows represent the sites of electrode patches. ERT, enzyme replacement therapy; SV, stroke volume; SI, stroke volume index; SVR, systemic vascular resistance; CO, cardiac output; ICON, index of contractility; CI, cardiac index.
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F1
Occasional shortness of breath was noticed (Figure 1A). X-ray showed cardiomegaly (Supplementary Figure 1A). Upon arriving in the operating room, pulse oximetry, and electrical cardiometry technology (ICON  Osypka Medical GmbH, Berlin, Germany) (Figures 1B,C) were applied before induction.
The changes of ICON, STR, MAP, TFC, and SVV during the operation. (A) During maintenance, ICON was mainly affected by the setting of inhalational agent concentration and inspiratory pressure in the ventilator. The arrowhead indicates the increased sevoflurane concentration before incision; the arrow indicates the alteration of ventilator setting: PInsp from 11 to 13 cm H2O, respiratory rate from 30 to 28 breaths per minute (normal range of ICON: 45.0-75.0). (B) Changes in STR and 1/ICON were compatible, and STR seemed to react earlier, providing anesthesiologists a faster reference to adjust the anesthesia. (C) Fluid is another factor influencing perfusion. Regardless of the trend of change in TFC and SVV, MAP was able to compensate in a relatively stable range (Normal range of TFC: 25-35, SVV: 5-15%). ICON, index of contractility; STR, systolic time ratio; TFC, thoracic fluid content; MAP, mean arterial pressure; PInsp, inspiratory pressure.
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F2
Figure 2. Fifty minutes after anesthesia induction, we changed the ventilator setting and increased PInsp from 13 to 15 cm H2O.