K/C/O complex congenital heart disease, transposition of great arteries with atrial septal defect, ventricular septal defect and patent ductusarteriosus with bidirectional shunt.

Came with chief complaints of pain in abdomen since 1 month. She was diagnosed as torsion of ovarian cyst and posted for laparotomy. After a detailed history and thorough physical examination, she was appropriately investigated. Echo verified her heart ailment and showed a bidirectional shunt.

Patient was explained about the procedure and the risk involved and informed high risk consent was taken. She was started on IV fluids on the night prior to surgery. Infective endocarditis prophylaxis was given 1 hour prior to surgery. No sedative pre-medication was used.

After shifting to OT, standard pre-induction ASA monitors were connected. Arterial line, Right Radial artery and central line, Right Internal Jugular Vein were cannulated.

Epidural was secured at T10-T11 and patient was positioned supine. Graded epidural was given using 2% lignocaine-adrenaline 2ml every 5 minutes followed by bupivaciane 0.5%. Phenylephrine infusion was started prophylactically and titrated to effect.

After about 50 minutes of induction, a level of T6 was attained. Intra-op period was uneventful.

Patient was extremely co-operative during the entire period. After surgery, she was shifted to ICU for monitored care