Canadian Journal of Anesthesia, Vol 30, 72-76, Copyright © 1983 by Canadian Anesthesiologists' Society

Low Thoracic Epidural Anaesthesia for Elective Cholecystectomy in a Patient with Congenital Heart Disease and Pulmonary Hypertension

¹ Department of Anesthesia, Brigham & Women's Hospital, Harvard Medical School

Address Correspondence to: Dr. S. Rao Mallampati, Dept. of Anesthesia, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115.

A 52-year-old male with pulmonary hypertension secondary to partial anomalous pulmonary venous return unassociated with atrial septal defect was given thoracic epidural anaesthesia for elective cholecystectomy. Partial anomalous pulmonary venous return is a rare congenital anomaly characterized by increased pulmonary blood flow which in severe cases results in pulmonary hypertension subjecting the right ventricle to strain. An epidural catheter was placed at the T₁₁-T₁₂ interspace and anaesthesia was established to the T₄ dermatomal level with bupivacaine (180 mg) and lidocaine (100 mg). Central venous pressure, pulmonary artery pressure, radial artery pressure, and cardiac output were monitored. There was minimal change in pulmonary arterial pressure, although there was a significant drop in systemic arterial pressure. Thoracic epidural block is recommended for upper abdominal surgery in clinical situations with pulmonary hypertension.

Key Words: ANAESTHETIC TECHNIQUES: epidural • LUNG: pulmonary artery hypertension