Intravenous anesthesia with nitroglycerin inhalation for surgical abortion in a patient with severe congenital heart disease and low oxygen saturation: A case report

INTRODUCTION: Congenital heart disease and pulmonary arterial hypertension are perilous to a gravida for the high morbidity and mortality. CASE PRESENTATION: We report an extremely rare case of a 27-year-old gravida with congenital heart disease and severe pulmonary arterial hypertension of 115 mmHg. Arterial blood gas analysis revealed her oxygen saturation (SpO(2)) of 67.8% and oxygen partial pressure of 40.0 mmHg, which were severely low. The patient was diagnosed as having gestation combined with congenital heart disease, severe pulmonary arterial hypertension, and hypoxemia. Interventions: The patient was treated with surgical abortion. The patient was monitored with invasive blood pressure (BP), electrocardiogram (ECG), heart rate, SpO(2), and arterial gas analysis as from entry into the operation suite. We performed total intravenous anesthesia with nitroglycerin inhalation. She was returned to the ward at the end of surgery. CONCLUSION: To our knowledge, this is the first reported case in a gravida with severe heart disease and very low SpO(2). Nitroglycerin inhalation may provide dilation of the pulmonary artery, reduction of pulmonary artery pressure, and improvement of oxygenation. Our case report may provide alternative regimen to anesthesia practitioners in similar circumstances.