THE ANESTHETIC MANAGEMENT OF THE CHILD WITH EISENMENGERS-SYNDROME

There is little clinical data in the literature on the anaesthetic man agement of paediatric patients with Eisenmenger's syndrome undergoing non-cardiac surgery. This paper reviews our experiences with eight suc h patients who underwent a total of II surgical procedures. Of the eig ht children, six had Down's syndrome and an atrio-ventricular septal d efect, one had a ventricular septal defect and one an atrial septal de fect. Nine of the eleven operations consisted of minor dental, plastic or ENT procedures, while one patient underwent two laparotomies. Pre- medication (trimeprazine/meperidine combination or midazolam) was admi nistered on three occasions. Induction of anaesthesia was achieved by either inhalation of halothane (2), or intravenously with thiopentone (6), ketamine (2) or propofol (1). Muscle relaxation and mechanical ve ntilation were employed only for both intra-abdominal procedures, othe rwise patients were allowed to breathe spontaneously with, or without, manual assistance. Halothane (8), isoflurane (2) and enflurane (1) we re all used for maintenance of anaesthesia. Non-invasive monitoring wa s applied intraoperatively for minor procedures, and arterial and cent ral venous catheters inserted for the laparotomies. Postoperative anal gesia for both these cases was provided by an epidural infusion of bup ivacaine 0.125% and fentanyl 5 mu g . ml(-1). A single im bolus of mor phine was required following a dental clearance, otherwise pain relief for the rest of the cases was achieved by local anaesthetic infiltrat ion and NSAIDS. With the exception of a single episode of bradycardia, induction, maintenance and recovery from anaesthesia were well tolera ted in all cases. In conclusion, our experience suggests that despite theoretical risks, children with Eisenmenger's syndrome appear to tole rate a variety of anaesthetic techniques.