Anaesthetic management for a patient with Eisenmengers syndrome undergoing ovarian cystectomy

Abstract

Eisenmenger's syndrome is a cyanotic congenital heart disease, where septal defects or patent ductus arteriosus advances to pulmonary hypertension with reversed/ bidirectional shunt. Any condition that lowers systemic vascular resistance, increases the degree of right to left shunt and the risk for the patient. Case Presentation: We report anaesthetic management of a 25-year-old P2L2 Female weighing 50kg with Eisenmenger's syndrome presented with an 8.3cm×7.5cm×8.4cm right ovarian cyst posted for ovarian cystectomy. The procedure was done under epidural anaesthesia, & post-operatively epidural analgesia was administered for 48 hours. After removal of epidural catheter, multimodal analgesia and anticoagulant therapy with Low Molecular Weight Heparin (LMWH)5000 IU by subcutaneous route was initiated. The mainstay of anaesthetic management in Eisenmenger's syndrome revolves around providing analgesia without decreasing systemic vascular resistance, or increasing pulmonary vascular resistance. Other concerns are hypercoagulable state, global hypoxia, Volume overload, hypercarbia, acidosis, hypovolemia. Systemic hypotension and increased pulmonary resistance associated with General Anaesthesia, & marked sympathectomy associated with spinal anaesthesia make both these modes of anaesthesia relatively risky compared to the plain epidural. Other concerns addressed during perioperative management were Oxygen support, early thromboprophylaxis, infective endocarditis prophylaxis, fluid restriction, and correction of acidosis.