Anaesthesia for laparoscopic cholecystectomy in a patient with Eisenmenger's syndrome

Sammut, Mario; Paes, M.L.

doi:10.1093/bja/79.6.810

Cited by 21 publications

(14 citation statements)

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“…These agents are likely to be required regardless of the anaesthetic technique used. Norepinephrine,13 metaraminol4 and phenylephrine6 have all been used successfully. Our patient required a continuous background infusion of phenylephrine with intermittent small boluses of metaraminol to maintain stable arterial pressures and oxygen saturations.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management of hip arthroplasty in an individual with trisomy 21 and Eisenmenger's syndrome

Bilak

Saddler

2013

BMJ Case Reports

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A 49-year-old man with trisomy 21 and Eisenmenger's syndrome presented for hip arthroplasty. Eisenmenger's syndrome is defined by the presence of obstructive pulmonary vascular disease secondary to long-standing left-to-right shunt causing pulmonary hypertension, eventually leading to shunt reversal in to right-to-left direction. Patients with Eisenmenger's syndrome pose a significant perioperative risk because of the physiological alterations induced by anaesthetic agents. The choice of anaesthetic technique in these patients is therefore not straightforward. A successful outcome was achieved with general anaesthesia supplemented with nerve blocks.

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Section: Discussionmentioning

confidence: 99%

Anaesthetic management of hip arthroplasty in an individual with trisomy 21 and Eisenmenger's syndrome

Bilak

Saddler

2013

BMJ Case Reports

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“…Anaesthetic management aims to control the intracardiac shunt by manipulation of cardiac physiology [5] and maintenance of right ventricular perfusion pressure.…”

Section: Discussionmentioning

confidence: 99%

“…Anaesthetic management of patients with Eisenmenger's syndrome undergoing noncardiac surgery has been described without the use of a pulmonary artery flotation catheter [5]. This allowed no assessment of shunt or pulmonary artery pressures, and relied on monitoring of saturations and systemic pressures.…”

Section: Discussionmentioning

confidence: 99%

Peri‐operative trans‐oesophageal echocardiography and nitric oxide during general anaesthesia in a patient with Eisenmenger's syndrome

Bouch¹,

Allsager

Moore

2006

Anaesthesia

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SummaryWe describe the peri-operative care of a patient with Eisenmenger's syndrome presenting for laparotomy. These patients require techniques to prevent the potential increase in intracardiac shunt caused by anaesthesia, by minimising increases in pulmonary artery pressure and reductions in systemic vascular resistance. The successful use of combined epidural and general anaesthesia with elective use of inhaled nitric oxide as a pulmonary vasodilator, and intra-operative trans-oesophageal echocardiography is described. In 1897, Eisenmenger described pulmonary vascular pathology related to a ventricular septal defect with right ventricular hypertrophy [1]. In 1958, the term Eisenmenger complex was used to describe pulmonary hypertension as a consequence of raised pulmonary vascular resistance (over 800 dyne.s )1 .cm) with reversed or bidirectional shunting through a large ventricular septal defect [2]. The term Eisenmenger's syndrome is applied where communication exists between the pulmonary and systemic circulations, with resultant pulmonary vascular pathology and cyanosis as a consequence of a reversed or bidirectional shunt [2,3], the shunt position being immaterial [2].With advances in medical care, patients with Eisenmenger's syndrome are surviving well into adulthood and are more likely to require non-cardiac surgery [4]. In this group of patients, the leading cause of peri-operative death relates to cardiac morbidity associated with alteration of the ratio of pulmonary to systemic pressures secondary to surgery and anaesthesia. Mortality rates of up to 30% are frequently quoted for this group of patients undergoing non-cardiac surgery [4]. Case reportA 43-year-old woman with Crohn's disease presented with repeated progressive episodes of bowel obstruction, secondary to a terminal ileal stricture. At 27 years of age, following the birth of her fourth child, a diagnosis of pulmonary hypertension secondary to an atrial septal defect was made, which progressed to Eisenmenger's syndrome over the next 5 years.History revealed a patient with only mild symptoms of dyspnoea on reaching the top of a flight of stairs, but who continued to smoke cigarettes, with a 20 pack year history. Daily medications were warfarin, inhaled steroid and b 2 agonist, with nicardipine for treatment of pulmonary hypertension. She was taking no medications for Crohn's disease.On examination, she weighed 45 kg, had finger clubbing, a loud second heart sound and raised jugular venous pulse but no peripheral oedema or hepatomegaly. Arterial pressure measured non-invasively was 85 ⁄ 40 mmHg, and heart rate was 90 beats.min )1 . Electrocardiogram showed sinus rhythm with right axis deviation and right ventricular hypertrophy. Results of a recent cardiac catheterisation (performed for pulmonary assessment) revealed pulmonary artery pressures of 98 ⁄ 27 mmHg (mean 53 mmHg), mean right atrial pressure of 4 mmHg, mean pulmonary capillary wedge pressure 6 mmHg, with systemic arterial pressures of 95 ⁄ 42 mmHg and pulmonary-systemic flow ratio ...

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“…Norepinephrine may cause anxiety, headache, photophobia, pallor, sweating, and chest pain in an awake patient. A norepinephrine infusion, started before induction, was advocated by Sammut and Paes (5). Despite this measure, desaturation could not be avoided during transfer to theatres.…”

Section: Discussionmentioning

confidence: 99%

“…In previous reports, a variety of techniques have been used to anaesthetize patients with Eisenmenger's syndrome for non‐cardiac surgery (4–6). However, most of the published papers focus either on the parturient (2, 3, 7, 8) or children, particularly with Down's syndrome (9, 10).…”

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confidence: 99%

Anaesthesia for cholecystectomy in two non‐parturients with Eisenmenger's syndrome

Kopka

McMenemin

Serpell

et al. 2004

Acta Anaesthesiol Scand

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Eisenmenger's syndrome consists of high pulmonary vascular resistance with reversed or bidirectional shunt at aortopulmonary, ventricular or atrial level. We describe the anaesthetic management of two adult females with Eisenmenger's syndrome admitted for laparoscopic cholecystectomy. One patient suffered post-operative complications, but the other case was uncomplicated. We used sevoflurane and total intravenous anaesthesia to provide general anaesthesia. Both techniques were tolerated.

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Anaesthesia for laparoscopic cholecystectomy in a patient with Eisenmenger's syndrome

Cited by 21 publications

References 0 publications

Anaesthetic management of hip arthroplasty in an individual with trisomy 21 and Eisenmenger's syndrome

Anaesthetic management of hip arthroplasty in an individual with trisomy 21 and Eisenmenger's syndrome

Peri‐operative trans‐oesophageal echocardiography and nitric oxide during general anaesthesia in a patient with Eisenmenger's syndrome

Anaesthesia for cholecystectomy in two non‐parturients with Eisenmenger's syndrome

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