Anaesthetic management Of Cerebral abscess drainage In a child with uncorrected Double outlet right ventricle (DORV) a case report

Abstract

Introduction: Double Outlet Right Ventricle is a cyanotic congenital heart disease where both the great arteries, aorta and pulmonary artery arise from the morphologic right ventricle and a ventricular septal defect(VSD) is present. Children with uncorrected DORV can present for non-cardiac surgeries. Such patients are at a higher risk to develop cerebral abscess because of right to left shunting of blood and absence of pulmonary clearance of microorganisms. Such cases pose a significant challenge for the anesthesiologists. Case summary: I present a case of six years female child with uncorrected DORV with multiple cerebral abscess, grade 4 clubbing with presence of central cyanosis and peripheral oxygen saturation of 73% on room air. Central nervous system examination revealed a drowsy child with features of raised ICP and a GCS of E4V2M5. The child underwent drainage of brain abscess under general anesthesia with controlled mechanical ventilation and invasive monitoring and had uneventful recovery. Conclusion: The mainstay of anaesthetic management of a patient with uncorrected congenital cyanotic heart disease aims at maintaining systemic vascular resistance(SVR) higher than pulmonary vascular resistance(PVR). Reduction in PVR can be achieved by increasing inspired oxygen concentration, countering acidosis by elective hyperventilation, avoiding hypothermia, hypercarbia and acidosis. Keywords: brain abscess; congenital; double outlet right ventricle