Anesthesia Management of Sectio Caesarian Patients with Eisenmenger Syndrome and Fetal Distress

Brief overview: 27 year old woman, G2P1A0 gravida 35-36 weeks with congenital heart disease (ventricular septal defect) that progresses to Eisenmenger syndrome, respiratory failure and fetal distress underwent an emergency caesarean section. Management: Anesthesia management was performed under general anesthesia with post-operative care in ICU. Prior to induction, pre-oxygenated with 100% O2 was performed, followed by Rapid Sequence Induction with Ketamine 70 mg, and Rocuronium 50 mg. After the patient had fallen asleep the Sellick maneuver was performed, intubated with ETT no. 6.5. Anesthesia maintenance with Sevoflurane 1 vol%, and 100% oxygen. Fentanyl 50 μg was given after the baby was born. Outcome: In this patient, general anesthetic technique was preferred over regional anesthetic technique for better maternal and fetal outcomes because this patient had already experienced respiratory failure and fetal distress, so a caesarean section was decided as soon as possible. The operation lasted for two hours, with SpO2 during the operation reaching 85% and a live baby boy was born with APGAR scores at the 1st ,3rd and 5th minute 6. Postoperatively, the patient remained intubated and was transferred to the intensive care unit with vital signs blood pressure 122/80 mmHg, pulse 96 beats per minute, SpO2 82-85%.