Journal of the Formosan Medical Association
Volume 106, Issue 3, Supplement , Pages S50-S53, 2007

Low-dose Bupivacaine–Fentanyl Spinal Anesthesia for Lower Extremity Surgery in a Nonparturient with Eisenmenger's Syndrome

  • Chia-Wen Chen

      Affiliations

    • Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
    • National Yang-Ming University School of Medicine, Taipei, Taiwan
    • ,
  • Kwok-Hon Chan

      Affiliations

    • Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
    • National Yang-Ming University School of Medicine, Taipei, Taiwan
    • ,
  • Chia-Fang Hsieh

      Affiliations

    • Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
    • National Yang-Ming University School of Medicine, Taipei, Taiwan
    • ,
  • Mei-Yung Tsou

      Affiliations

    • Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
    • National Yang-Ming University School of Medicine, Taipei, Taiwan
    • ,
  • Cheng-Ming Tsao

      Affiliations

    • Department of Anesthesiology, Chutung Veterans Hospital, Hsinchu, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Cheng-Ming Tsao, Department of Anesthesiology, Chutung Veterans Hospital, 81, Section 1, Jhongfong Road, Jhudong, Hsinchu 310, Taiwan

Received 17 January 2006; received in revised form 20 February 2006; accepted 4 April 2006.

Article Outline

Perioperative mortality in patients with Eisenmenger's syndrome is very high, particularly following cesarean section. This case report describes the successful use of low-dose bupivacaine-fentanyl spinal anesthesia for lower extremity surgery in a nonparturient with Eisenmenger's syndrome. A 21-year-old woman with Eisenmenger's syndrome was scheduled to have a fibular head tumor excision. After placement of routine monitor and an arterial line, we inserted an epidural catheter at the L3-L4 interspace to cover a potential inadequate block and then we administered 6 mg of hyperbaric bupivacaine 0.5% with 20 mg of fentanyl intrathecally via a 27-gauge needle at the L4-L5 interspace. There were no hypotension, respiratory depression, hypoxemia, and other severe hemodynamic alterations. No drug was administered via the epidural catheter in the 2-hour operative period and the postoperative course was uneventful. Therefore, we propose that intrathecal opioids combined with local anesthetics may be an alternative anesthetic method in patients with Eisenmenger's syndrome. [J Formos Med Assoc 2007;106(3 Suppl):S50-S53]

Key Words:  Eisemenger's complex , fentanyl , local anesthetics , spinal anesthesia

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PII: S0929-6646(09)60367-3

doi:10.1016/S0929-6646(09)60367-3

Journal of the Formosan Medical Association
Volume 106, Issue 3, Supplement , Pages S50-S53, 2007

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