Epidural anesthesia for cesarean section in a patient with Eisenmenger's syndrome

Eisenmenger's syndrome is a complex combination of cardiovascular abnormalities and is defined as pulmonary hypertension at systemic pressure level with reversed or bi-directional shunt through an intracardiac or aortopulmonary communication. Patients with Eisenmenger's syndrome are at high risk for peripartum morbidity and mortality. Multigravid patients with this disease are therefore uncommon. We report the anesthetic management for cesarean section of a 27-year-old multigravid female at 35 weeks' gestation with Eisenmenger's syndrome. Titrated epidural anesthesia was administered with incremental doses of 2% lidocaine. Intraoperative course was uneventful except for an episode of hypotension immediately after delivery of the baby, which was managed successfully. We conclude that carefully titrated epidural anesthesia may be safe, appropriate, and effective for patients with Eisenmenger's syndrome for cesarean section.