Anesthetic management of a patient with single atrium and single ventricle

: A 41-year-old woman with single atrium and single ventricle at 6 weeks of gestation was scheduled for dilation and evacuation of the fetus. The PaO2 was 39 mmHg, while she was breathing room air. Dilatation of the uterine cervical canal was performed under spinal anesthesia using 2.0 ml of 0.5% hyperbaric bupivacaine one day before dilatation and evacuation of the fetus. A sensory anesthesia level of T 10-S 5 was achieved. The systolic blood pressure decreased to around 70 mmHg. On the next day, dilation and evacuation of the fetus was performed under spinal anesthesia using 1.5 ml of 0.5% isobaric bupivacaine. Sensory anesthesia level was L 1-S 5. There was no precipitous decrease in blood pressure. However, intravenous fentanyl was needed during the procedure. There was no cardiovascular or respiratory complication after anesthesia and surgery. The patient was discharged on the next day.