Cardiac decompensation in a patient with Eisenmenger syndrome undergoing T5-T7 levels laminectomy in the sitting position.

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. A few 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.