Anaesthesia for A Patient with Eisenmenger Syndrome Undergoing LSCS

Abstract Introduction: Eisenmenger syndrome is a cyanotic congenital heart condition with pulmonary hypertension and reversed shunt, often linked to septal defects. Pregnancy-related lowered systemic resistance intensifies right-to-left shunt, posing risks for both mother and foetus. Anaesthetic management during LSCS in Eisenmenger patients should prioritize stable hemodynamics, preventing hypotension that exacerbates shunting, adequate analgesia and ensuring proper lung gas exchange to reduce shunt and acidosis. Objectives: To provide safe general anaesthesia during caesarean section to the obstetric patient with Eisenmenger syndrome. Methods: A 24-year-old primigravida at 32 weeks of gestation presented to the emergency room with breathlessness, chest pain, and bluish nail discoloration lasting for 2 days. Her oxygen saturation was 80% on room air. On admission, a 2D-ECHO revealed an ostium secondum atrial septal defect (ASD) with bidirectional shunting, pulmonary artery systolic pressure of 45mmHg and right ventricular dysfunction. The patient underwent a planned caesarean section at 34 weeks under general anaesthesia with Injection Lignocaine 2%, Injection Etomidate 0.3mg/kg, Injection Fentanyl 75mcg iv as induction agents. Intraoperatively, prophylactic intravenous dobutamine at 5-20mcg/kg/min and bolus of injection Esmolol was given as needed. Patient delivered a male child of 1.6kg with APGAR score of 6/10 and 8/10 at 1 and 5 minutes. She remained hemodynamically stable throughout the surgery and was extubated. Conclusion: General anaesthesia technique with maintenance of hemodynamics as close to normal as possible can be used for successful management of patients with Eisenmenger syndrome.