2013 Volume 33 Issue 7 Pages 951-955
We experienced anesthetic management of an adult obese patient (body mass index=38 kg/m2) undergoing repair of a double-chambered right ventricle. The patient preoperatively complained of dyspnea, chest pain and tachycardia following light exercise such as walking. Anesthesia was induced with inhalational sevoflurane and iv fentanyl. The trachea was intubated after facilitating muscle relaxation by rocuronium bromide. As soon as manual ventilation with high positive airway pressure started, blood pressure rapidly decreased. Intermittent iv phenylephrine and fluid loading were performed against hypotension. A total of 2,600 ml of fluid was required to stabilize the patient's hemodynamics, and then surgery was performed uneventfully. In this case, high airway pressure may have reduced cardiac preload, resulting in augmentation of right intraventricular stenosis causing hypotension. Adequate cardiac preload may be crucial for stabilizing hemodynamics in patients with double-chambered right ventricle.