{
  "abstract": "Background and Aims A 53-year-old man presented with infected diabetic foot ulcer, dyspnea, weakness, and hyperglycemia. His foot ulcer had worsened prompting above-knee amputation. His medical history included: dextrocardia, uncontrolled diabetes, ischemic heart disease, heart failure, severe pulmonary hypertension, heart block with malfunctioning pacemaker, and chronic kidney disease. Preoperative assessment revealed hypoxia (SpO 2 88%), pulmonary congestion, and echocardiographic findings of dextro-transposition of the great arteries (d-TGA) with an atrial septal defect. This case underscores the anesthetic challenges in managing uncorrected congenital heart disease with multi-organ dysfunction during non-cardiac surgery, emphasizing hemodynamic optimization and perioperative risk mitigation. Given the high mortality of uncorrected TGA, reports on regional anesthesia for non-cardiac surgeries are limited.Methods Retrospective data collection from January 2025 – February 2025. Detailed history taking was done three times alongside referral to the available electronic medical records.Results Ultrasound-guided peripheral nerve blocks (PNBs) with 0.375% ropivacaine targeted the femoral (15 mL), lateral femoral cutaneous (10 mL), and subgluteal sciatic nerves (25 mL), sparing the obturator nerve. During the operation, the patient did not require further analgesics or a rescue block. Hemodynamics remained stable without the need for inotropic or vasopressor support.Abstract P161 Figure 1The preoperative chest X-ray revealed the presence of a cardiac pacemaker, hilar and basal pulmonary congestion, and diffuse ground-glass opacities, with both costophrenic angles appearing clearAbstract P161 Figure 2The preoperative ECG revealed low voltage, left bundle branch block, atrial fibrillation, and frequent unifocal premature ventricular contractions. The pacemaker was likely not functioning, as the ECG displayed bradycardia without spikesAbstract P161 Figure 3The postoperative chest X-ray showed worsening of the hilar and basal congestion, along with increased diffuse ground-glass opacities, suggesting progression of the underlying pulmonary pathologyConclusions PNBs are generally safe in cardiac patients but require dose adjustments in complex congenital heart disease to avoid systemic toxicity. For above-knee amputation, precise local anesthetic dosing is crucial due to the variable knee innervation. Despite risks like Local Anesthetic Systemic Toxicity (LAST) and nerve injury, meticulous planning—balancing pulmonary and systemic vascular resistances (PVR and SVR), normothermia, and anesthetic choice—enables safe anesthesia in high-risk cases like unrepaired TGA.",
  "authors": [
    {
      "affiliations": [
        "Anesthesia Department, Kuwait Hospital Sharjah – Emirates Health Services, Sharjah, UAE"
      ],
      "name": "Islam Masadeh"
    },
    {
      "affiliations": [
        "Anesthesia Department, Kuwait Hospital Sharjah – Emirates Health Services, Sharjah, UAE"
      ],
      "name": "Khaled Saed"
    },
    {
      "affiliations": [
        "Anesthesia Department, Kuwait Hospital Sharjah – Emirates Health Services, Sharjah, UAE"
      ],
      "name": "Bassam Hammad"
    }
  ],
  "title": "P161 A rare case: anesthetic challenges in an adult with uncorrected transposition of the great vessels for non-cardiac surgery",
  "uid": "bb11fa18-094a-5691-9639-b7d1d53d0b40"
}