Anesthesia for Pregnant Patients with Eisenmenger Syndrome

Abstract

The Eisenmenger syndrome is a form of cyanotic congenital heart disease that does not usually respond to corrective surgery, and its occurrence is very rare in pregnant women. There are ongoing debates regarding the management of Eisenmenger syndrome in this particular population, and the prognosis is not certain with regard to maternal, fetal, and neonatal outcomes. Eisenmenger syndrome develops in patients who have left-to-right shunts resulting in right heart volume overload. Although any intracardiac defect resulting in left-to-right shunting of blood can lead to volume and pressure overload, the shunt is most generally because of atrial septal or ventricular septal defects. Increased pulmonary vascular resistance is among the consequences of this volume overload, and it results in right ventricular enlargement, pulmonary hypertension, and reversal of the left-to-right shunt into a bidirectional or right-to-left fixed shunt. The skill and experience of the anesthesiologist on common potential intraoperative problems as well as the ability to respond to hemodynamic disturbances as quickly as possible bear much more importance than the specific technique or agent that is used. Regional anesthesia should be established with low dose of local anesthetic along with an opioid. The epidural should be induced slowly in order to avoid acute episodes of hypotension. In the case of a requirement for general anesthesia, rapid sequence induction is the standard technique. © Springer International Publishing AG, part of Springer Nature 2018.