Abstract
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 chotecystectomy. 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.
Résumé
On a administré à un patient de 52 ans, se présentant avec hypertension pulmonaire, secondaire à celle du retour veineux pulmonaire anomal mais ne se rapportant pas à la communication interauriculaire, l’anesthésie épidurale afin de faire l’opération de la cholécystomie. Un retour pulmonaire partiel et veineux est une anomalie congénitale, caractérisée par l’augmentation du débit pulmonaire sanguin qui, dans des cas graves, produit l’hypertension pulmonaire ayant pour résultat une surcharge d’effort du ventricule cardiaque droit. On a placé un cathéter épidural au T11-T12 et l’anesthésie a été administrée au niveau sous-cutané du T4 avec de la bupivacaine (180 mg) et de la lidocaine (100 mg). La pression veineuse centrale, la pression de l’artère pulmonaire, celle de l’artère radiale et te débit cardiaque ont été contrôlés. On observa seulement un changement minime de la pression artérielle pulmonaire mais la pression artérielle systémique baissa de manière significative. L’anesthésie êpidurale thoracique est donc recommandée dans les cas de chirurgie abdominale supérieure où il y a hypertension pulmonaire.
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References
Mascarenhas E, Javier RP, Samet P. Partial anomalous pulmonary venous connection and drainage. Am J Cardiol 1973; 31:512–8.
Frye RL, Krebs M, Rahimtoola SH, Ongley PA, Hallermann FJ, Wallace RB. Partial anomalous pulmonary venous connection without atrial septal defect. Am J Cardiol 1968; 22:242–50.
Rudolph AM. Congenital Disease of the Heart. Chicago: Year Book Medical Publishers, 1974: pp. 239–264.
Enson Y. Pulmonary heart disease:Relation of pulmonary hypertension to abnormal lung structure and function. Bull NY Acad Med 1977; 53: 551–66.
Cournand A, Riley RL, Himmelstein A, et al. Pulmonary circulation and alveolar ventilation-perfusion relationships after pneumonectomy. J Thorac Surg 1950; 19:80–116.
Lategola MT, Pressure-flow relationships in the dog lung during acute subtotal pulmonary vascular occlusion. Am J Physiol 1958; 192:613–9.
Spinnato JA, Kraynack BJ, Cooper MW. Eisenmenger’s Syndrome in pregnancy: Epidural anesthesia for elective cesarean section. N Engl J Med 1981; 304:1215–7.
Fukunaga AF, Epstein RM. Sympathetic excitation during nitrous oxide-halothane anesthesia in the cat. Anesthesiology 1973; 39:23–6.
Lappas DG, Buckley MJ, Laver MB, et al. Left ventricular performance and pulmonary circulation following addition of nitrous oxide to morphine during coronary-artery surgery. Anesthesiology 1975; 43:61–9.
Hilgenberg JC, McCammon RL, Stoelting RK. Pulmonary and systemic vascular responses to nitrous oxide in patients with mitral stenosis and pulmonary hypertension. Anesth Analg 1980; 59:323–6.
Widdicombe JG, Sterling GM. The autonomic nervous system and breathing. Arch Intern Med 1970; 126:311–29.
Greene NM, Physiology of Spinal Anesthesia, 3rd ed. Baltimore: Williams & Wilkins, 1981: pp. 27–28.
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Mallampati, S.R. Low thoracic epidural anaesthesia for elective cholecystectomy in a patient with congenital heart disease and pulmonary hypertension. Can Anaesth Soc J 30, 72–76 (1983). https://doi.org/10.1007/BF03007720
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DOI: https://doi.org/10.1007/BF03007720