Thyroidectomy for multinodular goiter in Eisenmenger syndrome: Perioperative anesthetic management

Patients with Eisenmenger syndrome (ES), characterized by irreversible pulmonary vascular obstructive disease due to an intracardiac shunt, present a very high perioperative risk during noncardiac surgery. The risk is related to severe pulmonary hypertension, right ventricular dysfunction, and potential hemodynamic instability. We report the case of a 68-year-old woman with ES who underwent total thyroidectomy and parathyroidectomy for primary hyperparathyroidism associated with a compressive multinodular goiter. Following multidisciplinary evaluation, surgery was performed under bilateral cervical plexus block combined with analgosedation, with stable intraoperative hemodynamics and an uneventful recovery. This case suggests that regional anesthesia may represent a safe option for selected high-risk patients when managed by a multidisciplinary team.