Safety of Low Flow Sevoflurane Anesthesia for Patient with Dextrocardia and Situs Inversus Totalis: A Case Report

Abstract

Introduction: Situs inversus totalis with dextrocardia also named situs inversus totalis is a rare congenital condition in which the anatomy of the abdominal and thoracic organs are arranged in a mirror image reversal of the normal positioning. Case Report: A 42-year-old Albanian female was scheduled for elective maxillofacial surgery, cyst in the left side of the neck, and previously undiagnosed dextrocardia with situs inversus was picked up in preanesthetic evaluation by an anesthesiologist, during auscultation of the heart revealed a grade 2/6 holosystolic murmur at the left parasternal border. General anesthesia was induced with propofol 3mg/kg, fentanyl 3mcg kg, rocuronium 1mg/kg to facilitate endotracheal intubation and maintained with sevoflurane 1.0- 1, 5 MAC, in O2 /N2O 50:50%. After tracheal intubation, the fresh gas flow was set to 4 L.min -1 (O 2 2 L.min, N 2O 2 L.min). When the target gas concentrations have been achieved, FGF was reduced in 1 l/min, with the relative proportion of O2 /N2O titrated to maintain the inspired oxygen fraction (FiO 2) between 0.30 and 0.35. Inhaled and exhaled gas concentrations were continuously monitored. The patient was calm after extubation (score 1-of agitation), awareness according to Awareness Categorization was pointed with score 1- no awareness. In the PACU she was hemodynamically stable and after full recovery returned to the ward. Results of arterial blood gas analyzes BUN, AST, ALT, LDH, glycemia, total bilirubin, proteinogram, haemogram and electrolytes were within normal reference range. Her postoperative course was uneventful and she was discharged on the third postoperative day. Conclusion: With particular attention in preanesthetic visit we managed to find out dextrocardia with situs inversus totalis. We realized low flow sevoflurane anesthesia, which showed to be safe.