piperidines and Eisenmenger-Complex

We present an emergency anesthetic management of craniotomy for a 22-year-old man with congenital cyanotic heart disease due to brain abscess. Pulmonary blood flow was completely supplied via major arteriopulmonay collatelal artery (MAPCA). This patient complicated with Eisenmenger syndrome, has no history of cardiac surgery but several times of craniotomy due to repeated brain abscess. Total intravenous anesthesia with propofol and remifentanil was induced and maintained. SpO2 and PaO2 were elevated after oxygen administration via mask. Although systemic blood pressure level was decreased by anesthesia and continuous infusion of vasopressors was required. Oxygenation parameters were unchanged. This indicates that blood flow through MAPCA did not respond to changes in of respiratory and circulatory circumstances during anesthesia.

Topics: Anesthesia, Intravenous; Brain Abscess; Craniotomy; Cyanosis; Eisenmenger Complex; Emergencies; Heart Defects, Congenital; Humans; Intraoperative Care; Male; Piperidines; Propofol; Recurrence; Remifentanil; Vasoconstrictor Agents; Young Adult

We describe a case of 41-yr.-old multigravida at 35 weeks gestation, with a diagnosis of Eisenmenger syndrome, requiring urgent Cesarean section. The parturient had signs and symptoms of respiratory distress due to high pulmonary artery pressure, and the pregnancy was complicated by preeclampsia. A general anesthetic consisting of ketamine and etomidate and an intravenous infusion of remifentanil were used to provide stable anesthesia and analgesia for a successful delivery. The baby was delivered with high Apgar scores. The potential benefits and safety of the use of remifentanil in parturients with high pulmonary artery pressures are discussed.

Topics: Adult; Anesthesia, Obstetrical; Anesthetics, Combined; Anesthetics, Intravenous; Cesarean Section; Eisenmenger Complex; Etomidate; Female; Humans; Ketamine; Piperidines; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Remifentanil

Eisenmenger's syndrome consists of high pulmonary vascular resistance with reversed or bidirectional shunt at aortopulmonary, ventricular or atrial level. We describe the anaesthetic management of two adult females with Eisenmenger's syndrome admitted for laparoscopic cholecystectomy. One patient suffered post-operative complications, but the other case was uncomplicated. We used sevoflurane and total intravenous anaesthesia to provide general anaesthesia. Both techniques were tolerated.

Topics: Adult; Analgesics; Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Cholecystectomy, Laparoscopic; Echocardiography; Eisenmenger Complex; Female; Fentanyl; Humans; Intermittent Positive-Pressure Ventilation; Intubation, Intratracheal; Ketamine; Methyl Ethers; Piperidines; Postoperative Complications; Propofol; Remifentanil; Sevoflurane; Shock