Turkish Neurosurgery 2009 , Vol 19 , Num 1
Cardiac Decompensation in a Patient with Eisenmenger Syndrome Undergoing T5-T7 Levels Laminectomy in the Sitting Position
Zahid Hussain KHAN1, Ali Akbar ZEINALOO2, Razmeh Hussain KHAN3, Mohammad R. RASOULİ4
1,3,4Imam Khomeini Hospital, Anesthesiology Department, Tehran University of Medical Sciences, Islamic Republic of Iran
2Children's Medical Center, Pediatric Cardiology, Tehran, Islamic Republic of Iran
Although several different anesthetic techniques have been employed for noncardiac surgery in Eisenmenger syndrome (ES), the best anesthetic technique is still controversial. A17-year-old male with ES and an epidural abscess at the T5- T7 levels was scheduled to undergo laminectomy in the sitting position. Anesthesia was induced by ketamane and maintained with an opioid-isoflurane technique. Afew minutes after extubation, respiratory distress appeared and the patient was reintubated. He was transferred to the intensive care unit (ICU) and maintained on spontaneous intermittent mandatory ventilation and pressure support for 24 hours, and discharged fully recovered on the 4th postoperative day. To our knowledge this is the first case where the sitting position has been adopted for evacuation of an epidural abscess at the T5-T7 levels in a patient with ES. We recommend late extubation and an overnight observation in the ICU for such patients to prevent dangerous sequelae. Keywords : Eisenmenger syndrome, Epidural abscess, Ketamine, Sitting position, Late extubation
Corresponding author : Zahid Hussain Khan, khanzh51@yahoo.com