Bariatric Surgery in Patient with Atrial Septal Defect and Arrhythmogenic Right Ventricular Dysplasia: an Anesthetic Challenge

Introduction: Quick and smooth recovery after bariatric surgery for morbidly obese patients may pose a challenge to anesthesiologists, especially if there is any cardiac comorbidity. The addition of spinal anesthesia besides general anesthesia is a strategy that can be considered in this procedure. Case description: The 27 y.o. woman with a BMI of 53,8 kg/m2, atrial septal defect, and arrhythmogenic right ventricular dysplasia planned for bariatric surgery. The patient received preoxygenation for 24 hours before the day of surgery. After standard bedside monitoring for surgery had been applied, spinal anesthesia was administered at lumbal level L1–L2. General anesthesia was conducted after confirmation of a successful neuraxial block. Modifications of the surgical technique include low-flow CO2 insufflation. An episode of hypotension occurred once during the procedure and has been treated successfully with a 10 mg ephedrine bolus. Ventricle extrasystole appeared several times, but resolved with increasing oxygen fraction. Before extubation, infiltration of bupivacaine was done on a surgical wound. Paracetamol was intravenously administered for analgesia post-surgery. The patient was content with the anesthesia management and returned home without any complications. Discussion: A combination of anesthetic modalities may provide good abdominal relaxation, reduce the intraabdominal pressure during pneumoperitoneum, and reduce the use of muscle relaxants and opioids, which is important to gain optimal results in morbidly obese patients. Conclusions: General anesthesia is widely used for laparoscopic bariatric surgery. The addition of spinal anesthesia in morbidly obese simple left-to-right atrial septal defect patients is still safe and may be a good alternative technique in selected cases.