PERIOPERATIVE MANAGEMENT OF PATENT DUCTUS ARTERIOSIS WITH EISENMENGERS SYNDROME WITH SEVERE PULMONARY HYPERTENSION POSTED FOR NON-CARDIAC SURGERY.

Victor Eisenmenger's initial definition of Eisenmengers syndrome was redefined by Wood as 'the presence of high pulmonary vascular resistance associated with pulmonary artery hypertension at or close to systemic pressure associated with a reversed or bi-directional shunt at the aortopulmonary, interatrial or interventricular level'. Survival beyond 50 years is unusual, but patients may lead a relatively active and productive life in early adulthood and will therefore present from time to time for noncardiac surgery. Though theoretical risks of anaesthesia are considerable patients are known to do well with a variety of techniques, if pathophysiology of the disease is well understood.We describe the anaesthetic management of the patient with Eisenmengers syndrome with abnormal uterine bleeding with multiple fibroids.She underwent a total abdominal hysterectomy after pre-operative stabilization.Anaesthetizing such a decompensated patient is an anaesthetic challenge.

A High Performance Liquidc Chromatography Method for the Analysis of Total and Free Indomethacin in Serum

A simple rapid and sensitive HPLC technique for the analysis of total and free plasma indomethacin concentrations in neonates is described. The advantages of the technique are small sample volumes (50 μL) enabling the use of capillary samples, direct extraction, low limits of detection (20 ng/mL) and good precision (CV<7% between-batch). Indomethacin and the internal standard (flufenamic acid) eluted within 12 min and the peaks were unaffected by indomethacin metabolites or by a number of commonly used drugs. The technique is suitable for the investigation into the pharmacokinetics of total and free indomethacin, in neonates with patent ductus arteriosis, and could be used to define a therapeutic window for free indomethacin levels to enable therapeutic drug monitoring to occur in this condition.