Safe and Effective Perioperative Management in Patients with Atrial Septal Defect and Pulmonary Contusion: A Case Study with Supraclavicular Block

RTH Supraptomo RTH Supraptomo; Andy Nugroho; Muhammad Baihaqi Siddik

doi:10.14710/jai.v0i0.78083

DOI: https://doi.org/10.14710/jai.v0i0.78083

Safe and Effective Perioperative Management in Patients with Atrial Septal Defect and Pulmonary Contusion: A Case Study with Supraclavicular Block

RTH Supraptomo RTH Supraptomo¹ , Andy Nugroho¹, Muhammad Baihaqi Siddik²

¹Anesthesiologist, Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Sebelas Maret, Dr. Moewardi General Hospital, Central Java, Indonesia, Indonesia

²Anesthesiology Resident, Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Sebelas Maret, Dr. Moewardi General Hospital, Central Java, Indonesia, Indonesia

Received: 25 Sep 2025; Revised: 13 Apr 2025; Accepted: 22 Apr 2025; Available online: 23 Apr 2025.

This work is licensed under a Creative Commons Attribution 4.0 International License.

BibTex Citation Data :

@article{JAI78083,
    author = {RTH Supraptomo RTH Supraptomo and Andy Nugroho and Muhammad Baihaqi Siddik},
    title = {Safe and Effective Perioperative Management in Patients with Atrial Septal Defect and Pulmonary Contusion: A Case Study with Supraclavicular Block},
    journal = {JAI (Jurnal Anestesiologi Indonesia)},
  volume = {0},
    number = {0},
    year = {2021},
    keywords = {Adult Congenital Heart Disease; Pulmonary Contusion; Radius fracture;  Supraclavicular block},
    abstract = {  Introduction:  Peripheral nerve blocks are a safe and effective anesthetic option for patients with congenital heart disease, offering significant advantages over general anesthesia by minimizing cardiovascular and pulmonary risks. The supraclavicular brachial plexus block, in particular, provides excellent anesthesia for upper limb surgery with fewer intraoperative and postoperative complications, faster recovery, and improved pain control  2 .   Case :  A 67-year-old woman with a large secundum ASD, severe pulmonary hypertension, right ventricular dysfunction, and bilateral lung contusions on the 10th day is scheduled for ORIF of a distal radius fracture. Given her high cardiopulmonary risk, regional anesthesia via ultrasound and Nerve Stimulator supraclavicular block using Levobupivacaine 0.375 % 20 ml was chosen to minimize hemodynamic instability and avoid complications from general anesthesia. The procedure is supported by intensive monitoring in the High Care Unit after the operation is complete, reflecting a careful, individualized approach for this high-risk geriatric patient.   Discussion :  Anesthetic management in patients with left-to-right shunt congenital heart disease requires preservation of hemodynamic stability and careful control of pulmonary and systemic vascular resistance. General anesthesia and mechanical ventilation may disturb the Qp:Qs balance and increase cardiopulmonary risk, particularly in the presence of pulmonary contusion, which predisposes to ventilator-induced lung injury and hypoxemia. In this case, ultrasound-guided supraclavicular brachial plexus block was selected to preserve spontaneous ventilation, maintain stable hemodynamics, and minimize pulmonary stress while providing effective surgical anesthesia.   Conclusion  Supraclavicular brachial plexus block may be a method to consider in patients with congenital heart disease and pulmonary contusion in patients with surgery below the shoulder.   Keywords : Adult Congenital Heart Disease, Pulmonary Contusion, Radius fracture, Supraclavicular block      },
   issn = {2089-970X},  doi = {10.14710/jai.v0i0.78083},
    url = {https://ejournal.undip.ac.id/index.php/janesti/article/view/78083}
}

Citation Format:

Abstract

Introduction: Peripheral nerve blocks are a safe and effective anesthetic option for patients with congenital heart disease, offering significant advantages over general anesthesia by minimizing cardiovascular and pulmonary risks. The supraclavicular brachial plexus block, in particular, provides excellent anesthesia for upper limb surgery with fewer intraoperative and postoperative complications, faster recovery, and improved pain control ².

Case : A 67-year-old woman with a large secundum ASD, severe pulmonary hypertension, right ventricular dysfunction, and bilateral lung contusions on the 10th day is scheduled for ORIF of a distal radius fracture. Given her high cardiopulmonary risk, regional anesthesia via ultrasound and Nerve Stimulator supraclavicular block using Levobupivacaine 0.375 % 20 ml was chosen to minimize hemodynamic instability and avoid complications from general anesthesia. The procedure is supported by intensive monitoring in the High Care Unit after the operation is complete, reflecting a careful, individualized approach for this high-risk geriatric patient.

Discussion : Anesthetic management in patients with left-to-right shunt congenital heart disease requires preservation of hemodynamic stability and careful control of pulmonary and systemic vascular resistance. General anesthesia and mechanical ventilation may disturb the Qp:Qs balance and increase cardiopulmonary risk, particularly in the presence of pulmonary contusion, which predisposes to ventilator-induced lung injury and hypoxemia. In this case, ultrasound-guided supraclavicular brachial plexus block was selected to preserve spontaneous ventilation, maintain stable hemodynamics, and minimize pulmonary stress while providing effective surgical anesthesia.

Conclusion Supraclavicular brachial plexus block may be a method to consider in patients with congenital heart disease and pulmonary contusion in patients with surgery below the shoulder.

Keywords: Adult Congenital Heart Disease, Pulmonary Contusion, Radius fracture, Supraclavicular block

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Keywords: Adult Congenital Heart Disease; Pulmonary Contusion; Radius fracture; Supraclavicular block

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Section: Case Reports

Language : EN

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