Combined spinal epidural anesthesia with epidural volume extension technique for hysterectomy in patient with unpalliated cyanotic heart disease--a case-report.

Adults with unrepaired cyanotic heart disease scheduled for a non-cardiac surgery present serious concerns for the anesthesiologists. Both general and regional anesthetic techniques have been safely reported in Eisenmenger's syndrome and adults with Tetralogy of Fallot (TOF) for non-cardiac surgery. The safety of low-dose sequential combined spinal epidural (CSE) technique in high-risk cardiac cases has recently been emphasized in obstetric anesthetic practice but to our knowledge, this technique has not been reported for hysterectomy in cyanotic heart disease patients in anesthetic literature. We report the successful management of hysterectomy in a patient with ventricular septal defect and pulmonary atresia (VSD-PA) using CSE anesthesia with epidural volume extension (EVE) technique.