Eisenmenger Syndrome

Eisenmenger Syndrome • Chronic Lt→ Rt shunt changes to Rt→ Lt • Pregnancy ↑ S/S due to ↓ SVR • hypoxia→ IUGR, demise • high rish of thromboembolic event mainly post partum • Hemodynamic Goals: o preload→ maintain, avoid AC compression → LUD o R/R → maintain normal sinus o Cont → maintain, avoid cardiodepressant o Afterload→ maintain, avoid sudden ↓ in SVR o PVR → avoid ↑ by hypoxia, acidosis, ↑ PCO2 • Consider inhaled NO, O2 all the time, with pulse oxi • Monitors → Art-line, PAC/CVP • For the 1st stage → single shot spinal opioids • 2nd stage may consider slow titrating epidural • Be aware that they could be anticoagulated • For C/S→ crash cart in the room, with pads on the Pt • Epidural have better outcome than GA→ careful titrate LA

• • • • • • •

With GA → PPV → ↓ preload, and inhalation agent → myocardial depression The dilemma wither to do RSI or slow induction With RSI→ sudden ↓ SVR and contractility → possible arrest With slow → risk of aspiration, but still better choice, after taking all measures to ↓ the risk of aspiration→ NPO, premed Opioids are good choice (Rami) for induction Avoid overzealous hydration + autotransfusion → volume overload Post-op ICU