Anesthetic management of a case of Gilbert's syndrome for mitral and aortic valve replacement: Role of transesophageal echocardiography

P S Nagaraja; Naveen G Singh; S Subash; N Manjunatha; C G Prabhushankar; N Sathish

doi:10.4103/1658-354X.197335

Anesthetic management of a case of Gilbert's syndrome for mitral and aortic valve replacement: Role of transesophageal echocardiography

Saudi J Anaesth. 2017 Jan-Mar;11(1):89-92. doi: 10.4103/1658-354X.197335.

Authors

P S Nagaraja¹, Naveen G Singh¹, S Subash¹, N Manjunatha¹, C G Prabhushankar¹, N Sathish¹

Affiliation

¹ Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.

Abstract

Gilbert's syndrome (GS) is an autosomal inherited disorder characterized by relative deficiency of glucuronyl transferase and poor uptake of unconjugated bilirubin by hepatocytes. Cardiac surgery on cardiopulmonary bypass (CPB) in these patients triggers further hepatic dysfunction. Transesophageal echocardiography (TEE) and Doppler assessment of hepatic vein help in assessing hepatic blood flow (HBF) during cardiac surgery. Here, we discuss anesthetic management and role of TEE in maintaining HBF perioperatively in a 25-year-old male patient with GS undergoing double valve replacement with tricuspid valve plasty. TEE-guided HBF monitoring and management of hepatic perfusion by modifying anesthetic and CPB protocol resulted in the favorable outcome.

Keywords: Bilirubin; Gilbert syndrome; general anesthesia; transesophageal echocardiography.

Publication types

Case Reports