Low Dose Spinal Anesthesia in Pregnant Patient with Eisenmenger Syndrome undergoing Caesarean Section

Abstract

Pregnancy with Eisenmenger syndrome is pregnancy with a high mortality rate and it is even recommended not to get pregnant based on the World Health Organization pregnancy risk. The aim of this paper is to present a choice of anesthetic techniques to facilitate pregnant patients with Eisenmenger syndrome undergoing caeasarean section. A 25-year-old woman at 37 weeks' gestation came to the hospital with signs of labor accompanied by comorbid Eisenmenger syndrome. Caesarean section was facilitated with spinal anesthesia with bupivacaine heavy 0.5% 7.5 mg, fentanyl 25 mcg at level L2-L3 while loading 250 ml of crystalloid fluid and preparing norepinephrine drip. The patient's hemodynamics can be stabilized by titrating norepinephrine drip to 0.2 mcg/kg/minute and the patient's shortness of breath is gradually reduced. The patient was treated in intensive care for 2 days and was allowed to be outpatient after 5 days of being treated in the postnatal ward. Appropriate perioperative management can provide optimal results and is expected to prevent fatal perioperative events. As conclusion, low-dose spinal anesthetic techniques can be an option to facilitate caesarean section in pregnant patients with Eisenmenger syndrome.