Low-dose bupivacaine-fentanyl spinal anesthesia for lower extremity surgery in a nonparturient with Eisenmenger's syndrome.
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.
Chen
Chia-Wen
CW
Department of Anesthesiology, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan.
Chan
Kwok-Hon
KH
Hsieh
Chia-Fang
CF
Tsou
Mei-Yung
MY
Tsao
Cheng-Ming
CM
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
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine