Anaesthethetic management of craniotomy for recurrent astrocytoma in case of large atrial septal defect with severe pulmonary hypertension: A case report

In adult population after bicuspid aortic valve, atrial septal defect (ASD) is the most common congenital acyanotic heart disease, with high prevalence in females. Large ASD pulmonary hypertension (PAH) posted for non-cardiac surgery poses a challenge to anaesthesiologists because intraoperative hypercarbia, hypoxemia, and hyperthermia can result increased vascular resistance (PVR), which shunt reversal, congestive failure, fatal arrhythmias. We report successful anaesthetic management of 48yrs female case recurrent astrocytoma craniotomy. Patient was having large ostium secundum (35 mm diameter), severe PAH PASP 75mmhg by TR jet, dilated RA/RV, moderate LVEF 55% under GA, titrated induction, avoiding rise PVR maintaining systemic (SVR) vasopressors intraoperatively avoid reversal. :To concludepatients PHT due ASD, require meticulous prevent any PAH, maintenance optimal oxygen delivery excellent postoperative analgesia outcome.