Korean J Anesthesiol.  2009 Nov;57(5):666-669. 10.4097/kjae.2009.57.5.666.

Anesthetic management for emergent craniotomy in a patient with Eisenmenger's syndrome: A case report

• Chung KH
• Kim SH
• Chun DH
• Lee JY
• Park SC
• Park CH
• Kim MG

• KMID: 2092260
• DOI: http://doi.org/10.4097/kjae.2009.57.5.666

Abstract

Eisenmenger's syndrome describes the elevation of pulmonary arterial (PA) pressure to the systemic level caused by an increased pulmonary vascular resistance with reversed or bi-directional shunt through an intracardiac or aortopulmonary communication. We report a case of an emergent craniotomy for cerebellar abscess in a 21-year-old male patient with Eisenmenger syndrome secondary to Large VSD. A PA catheter was inserted via right femoral vein, but could not be advanced pass the pulmonic valve. After futile attempts to place the catheter tip in the right ventricle. Anesthesia was induced with etomidate, rocuronium, midazolam and fentanyl and maintained with only high dose fentanyl. Milinone and norepinephrine were infused continuously to decrease right to left shunt. He was transferred to the intensive care unit under intubated state and treated with antibiotics for a few days due to intermittent high fever. The operation ended without major complications and the patient was discharged 42 days later.

Keyword

Eisenmenger's syndrome; Milrinone; Norepinephrine

MeSH Terms

Abscess
Androstanols
Anesthesia
Anti-Bacterial Agents
Catheters
Craniotomy
Eisenmenger Complex
Etomidate
Femoral Vein
Fentanyl
Fever
Heart Ventricles
Humans
Hypogonadism
Intensive Care Units
Male
Midazolam
Milrinone
Mitochondrial Diseases
Norepinephrine
Ophthalmoplegia
Vascular Resistance
Young Adult
Androstanols
Anti-Bacterial Agents
Etomidate
Fentanyl
Hypogonadism
Midazolam
Milrinone
Mitochondrial Diseases
Norepinephrine
Ophthalmoplegia