# Successful intraoperative management of laparoscopic hysterectomy in a patient with Eisenmenger syndrome: a case report

## TL;DR

This case report details the successful anesthetic management of a laparoscopic hysterectomy in a patient with Eisenmenger syndrome, focusing on balancing vascular resistance and minimizing risks.

## Contribution

The paper presents a novel case of successful laparoscopic surgery in a high-risk Eisenmenger syndrome patient with detailed anesthetic strategies.

## Key findings

- Maintaining euvolemia with noradrenaline helped manage systemic vascular resistance and cardiac output.
- Preventing factors like hypoxia and pain was critical to avoid increased pulmonary vascular resistance.
- Laparoscopic surgery was found to be less invasive and feasible for patients with Eisenmenger syndrome when carefully managed.

## Abstract

Patients with Eisenmenger syndrome (ES) requiring noncardiac surgery are at a significantly high risk of perioperative morbidity and mortality. However, perioperative management of patients with ES requiring laparoscopic surgery remains unclear.

We describe the case of a patient with ES who underwent laparoscopic hysterectomy under general anesthesia with a peripheral nerve block. The objectives of the perioperative management included the following: (1) maintaining systemic vascular resistance and cardiac output through euvolemia, facilitated by the infusion of noradrenaline, and (2) preventing a reduction in oxygen-carrying capacity and factors that elevate pulmonary vascular resistance, such as pain, hypoxia, and decreased body temperature. Although laparoscopic procedures involved an increased risk in patients with ES, they are less invasive than open surgeries.

This report describes the successful anesthetic management of a patient with ES, ensuring a balance between systemic and pulmonary vascular resistance.