Emergency appendectomy in a patient with Eisenmenger's syndrome

For the successful management of an emergency appendectomy and abscess drainage in an Eisenmenger's patient with diffuse peritonitis, it may be preferable to use general anesthesia with awake intubation. Epidural anesthesia is commonly combined with this anesthetic management for emergency abdominal surgery. However, the combination of topical anesthesia with epidural anesthesia should be avoided for fear of toxicity of local anesthetics in a patient with complications due to Eisenmenger's syndrome.