title: Anaesthetic management of breast surgery in a patient with Eisenmenger syndrome.
abstract: Eisenmenger syndrome (ES) is a complex combination of cardiovascular abnormalities defined as pulmonary hypertension with investment or bidirectional flow through an intracardiac or aortopulmonary communication, usually secondary to a congenital heart disease not resolved promptly. It carries a significant risk of perioperative mortality, with an incidence close to 30% for non-cardiac surgery. We report the anaesthetic management in a ES patient undergoing breast surgery, which was successfully performed under general anaesthesia combined with thoracic analgesic blocks. The main pathophysiological implications of this syndrome are discussed, emphasizing the importance of appropriate preoperative evaluation with thorough assessment of associated risks, careful intraoperative management, and postoperative care, which should be initially performed in a critical care unit. The need to individualize and tailor the choice of drugs and anesthetic technique to the hemodynamic condition of the patient and the surgical procedure is highlighted.
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitario Central de Asturias, Oviedo, España. Electronic address: jgalan01@hotmail.com.
authors.forename: J C
authors.initials: JC
authors.lastname: Galán Gutiérrez
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitario Central de Asturias, Oviedo, España.
authors.forename: F E
authors.initials: FE
authors.lastname: Fernández Suárez
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitario Central de Asturias, Oviedo, España; Unidad de Cirugía Mayor Ambulatoria, Servicio de Anestesiología y Reanimación, Hospital Universitario Central de Asturias, Oviedo, España.
authors.forename: P
authors.initials: P
authors.lastname: Miranda García
authors.affiliation: Unidad de Cirugía Mayor Ambulatoria, Servicio de Anestesiología y Reanimación, Hospital Universitario Central de Asturias, Oviedo, España.
authors.forename: L A
authors.initials: LA
authors.lastname: Sopena Zubiria
mesh_terms: D000768:Anesthesia, General / Q000379:methods*; D019072:Antibiotic Prophylaxis; D001943:Breast Neoplasms / Q000150:complications / Q000601:surgery; D004541:Eisenmenger Complex / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004696:Endocarditis / Q000517:prevention & control; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009407:Nerve Block / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional; D014655:Vascular Resistance
keywords: Anestesia general; Anestesia regional; Bloqueos torácicos; Breast; Cardiopatía congénita; Congenital heart disease; Eisenmenger syndrome; General anaesthesia; Hipertensión pulmonar; Mama; Pulmonary hypertension; Regional anaesthesia; Síndrome de Eisenmenger; Thoracic blocks