title: [Anesthetic management for emergency laparotomy in an adult patient with Eisenmenger syndrome: a case report].
abstract: There are few clinical reports concerning anesthetic management for patients with Eisenmenger syndrome requiring non-cardiac surgery. The risk of morbidity and mortality associated with non-cardiac surgery in patients with Eisenmenger syndrome is considerable. During anesthetic management for these patients, careful circulatory and respiratory managements to avoid several factors related to surgery and anesthesia that can potentially increase right to left shunt flow are required. Therefore, it is very important to maintain cardiac output to prevent a decrease in systemic vascular resistance and an increase in pulmonary vascular resistance. For this purpose, combination of intravenous administration of inotropes such as milrinone and dobutamine, and vasopressors such as norepinephrine, might have clinical efficacy. Here we describe an anesthetic management for a 50-year-old woman with a ventricular septal defect and Eisenmenger syndrome undergoing emergency laparotomy. We considered that sufficient fluid therapy and adequate administration of inotropes and vasopressors, based on strict hemodynamic assessment using direct arterial and central venous pressure monitoring, arterial blood gas analysis, and transesophageal echocardiography during general anesthesia, might have contributed to the uneventful perioperative course of the patient.
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Asamoto
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kitamura
authors.forename: Nagara
authors.initials: N
authors.lastname: Ohno
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Muroya
authors.forename: Yoshiteru
authors.initials: Y
authors.lastname: Mori
authors.forename: Kanako
authors.initials: K
authors.lastname: Sato
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Yamada
mesh_terms: D000768:Anesthesia, General; D002316:Cardiotonic Agents / Q000008:administration & dosage; D004280:Dobutamine / Q000008:administration & dosage; D004541:Eisenmenger Complex / Q000150:complications*; D004630:Emergencies; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000150:complications; D006439:Hemodynamics; D006801:Humans; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000517:prevention & control; D007813:Laparotomy; D008875:Middle Aged; D020105:Milrinone / Q000008:administration & dosage; D016343:Monitoring, Intraoperative; D009638:Norepinephrine; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents; D004280:Dobutamine; D020105:Milrinone; D009638:Norepinephrine