Anaesthesia for caesarean section in a pre-eclamptic patient with Ebstein's anomaly

Anaesthetic management for Caesarean section in a pre-eclamptic patient with Ebstein's anomaly and a right to left intracardiac shunt was accomplished under general anaesthesia. Air bubbles in the venous line were meticulously eliminated to prevent paradoxical air emboli. A rapid sequence induction using standard doses of thiopentone and succinylcholine did not result in loss of consciousness and muscle relaxation was inadequate for endotracheal intubation. This problem must be anticipated in patients with extremely enlarged right atria and the dose of induction agents should be increased. Carefully controlled epidural anaesthesia may be used if the cardiac reserve is adequate.