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Subarachnoid block in transurethral surgery for bladder tumor in Eisenmenger’s syndrome

Uncorrected left to right intracardiac shunts can progress to a reversal of shunting in the fourth or fifth decade of life due to severe pulmonary artery hypertension. As the changes in the pulmonary vasculature are irreversible at this stage the condition can only be palliated by medication. Regional anaesthesia decreases the systemic vascular resistance and increases the right to left shunt but in optimal doses can minimize this shunting while protecting from other adverse effects of general anaesthesia. We highlight the anaesthetic management of a 53 year old male with Eisenmenger’s syndrome with atrial septal defect on anti failure medications successfully managed with a low dose subarachnoid blockade for transurethral surgery. We believe that this simplified management while providing a safe protocol for use.