Non cardiac surgery in a patient with eisenmenger syndrome-anaesthesiologist′s challenge

Anaesthetic challenges in a patient with eisenmenger syndrome: A case report

“…7,8 Hence ketamine is the ideal agent to use as it does not reduce systemic vascular resistance. 4,9,10 Anaesthesiologist must avoid factors that increase pulmonary vascular resistance which include cold, hypercarbia, acidosis, hypoxia, αadrenergic agonists. 9 Nitrous oxide not used due its interference with pulmonary vascular resistance.…”

“…To avoid paradoxical embolization, all intravenous catheters must be free of air bubbles. 4,10,11 General anaesthesia is preferred than regional anaesthetic techniques due to later causing profonde hypotension due to autonomic blockade. 4,8,[10][11][12] Intermittent positive pressure ventilation was avoided as it decreases pulmonary blood flow and increase the right to left shunt.…”

“…4,10,11 General anaesthesia is preferred than regional anaesthetic techniques due to later causing profonde hypotension due to autonomic blockade. 4,8,[10][11][12] Intermittent positive pressure ventilation was avoided as it decreases pulmonary blood flow and increase the right to left shunt. 4,12 Pregnancy carries high risk of mortality about 30-45% and it positively correlate with degree of pulmonary hypertension.…”

Challenges in managing a critically ill patient with decompensated Eisenmenger syndrome

“…However, there is no evidence to suggest a preferred intravenous induction agent for patients with ES. Therefore, it is important to consider the patient’s overall clinical condition and the pharmacodynamic effects of the induction agents prior to selection 6. It is also advisable to institute invasive monitoring prior to induction, which includes invasive arterial BP monitoring and perhaps a Swan-Ganz catheter (also known as pulmonary artery catheter, PAC) for pressure measurements.…”