title: Low-dose bupivacaine-fentanyl spinal anesthesia for lower extremity surgery in a nonparturient with Eisenmenger's syndrome.
abstract: Perioperative mortality in patients with Eisenmenger's syndrome is very high, particularly following cesarean section. This case report describes the successful use of low-dose bupivacaine-fentanyl spinal anesthesia for lower extremity surgery in a nonparturient with Eisenmenger's syndrome. A 21-year-old woman with Eisenmenger's syndrome was scheduled to have a fibular head tumor excision. After placement of routine monitor and an arterial line, we inserted an epidural catheter at the L3-L4 interspace to cover a potential inadequate block and then we administered 6 mg of hyperbaric bupivacaine 0.5% with 20 microg of fentanyl intrathecally via a 27-gauge needle at the L4-L5 interspace. There were no hypotension, respiratory depression, hypoxemia, and other severe hemodynamic alterations. No drug was administered via the epidural catheter in the 2-hour operative period and the postoperative course was uneventful. Therefore, we propose that intrathecal opioids combined with local anesthetics may be an alternative anesthetic method in patients with Eisenmenger's syndrome.
authors.affiliation: Department of Anesthesiology, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Chia-Wen
authors.initials: CW
authors.lastname: Chen
authors.forename: Kwok-Hon
authors.initials: KH
authors.lastname: Chan
authors.forename: Chia-Fang
authors.initials: CF
authors.lastname: Hsieh
authors.forename: Mei-Yung
authors.initials: MY
authors.lastname: Tsou
authors.forename: Cheng-Ming
authors.initials: CM
authors.lastname: Tsao
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001859:Bone Neoplasms / Q000601:surgery*; D002045:Bupivacaine / Q000008:administration & dosage*; D004541:Eisenmenger Complex / Q000150:complications; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D005360:Fibula / Q000601:surgery*; D006801:Humans
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine