A case experience of a patient with Eisenmenger's syndrome requiring dental treatment under general anesthesia

• Published in: Journal of Japanese Society of Dentistry for Medically Compromised Patient Vol. 15; no. 2; pp. 103 - 107
• Main Authors: Ishigaki, Yoshiki, Abe, Keiichi, Nakamura, Kiminari, Ishii, Tatsuya, Seki, Shintaro
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of Dentistry for Medically Compromised Patient 31.08.2006
• Subjects: dental treatment; Eisenmenger syndrome; intravenous anesthesia
• ISSN: 0918-8150; 1884-667X
• DOI: 10.11255/jjmcp1992.15.103

We experienced a case of Eisenmenger's syndrome requiring dental treatment under intravenous anesthesia. A 35 -year-old male and his parents were referred to our department with chief complaint of severe pain in the left upper first and second molar regions. The patient's past medical history revealed delay in mental development, and Eisenmenger syndrome. Patient cooperation for routine dental treatment was not obtained and was possible with the use of general anesthesia, intravenous anesthesia, or inhalation sedation with nitrous oxide and oxygen together. There were a few considerations concerned with the patient's cardiac functions and since the depth of anesthesia can be easily adjusted, we extracted the tooth under intravenous anesthesia utilizing Propofol. The circulatory function was controlled with the use of Propofol and a preventative measures for shunt formation, we administered Dopamine continuously. Please clarify what is meant here: 2-double-diluted = 4 dilutions [double-diluted = 2 dilutions] therefore 2-doubleidiluted = 4 dilutions 2% lidocaine Hydrochloride containing 1 : 80000 Epinephrine with 2% lidocaine Hydrochloride and Propitocaine H ydrochloride containing 0.03IU felypressin 1.8ml. Conclusively, we were able to treat the patient without substantial changes in the hemodynamic state or circulatory conditions. With careful anesthetic management, it was possible to provide and perform dental treatments to these patients with Eisenmenger's syndrome without complications during treatment, such as aggravation of hypoxemia. However, it is necessary that total body management be carefully planned and considerations for an unexpected episode like a tantrum or a fit that may occur during the treatment be speculated and how to manage such episode be planned ahead so that immediate actions can be taken.