Ketamine–dexmedetomidine total intravenous anaesthesia with NIRS-guided oxygenation in an adult with cyanotic congenital heart disease undergoing craniotomy: A case report

Background: Anaesthesia management in patients with cyanotic congenital heart disease (CCHD) undergoing craniotomy presents unique challenges due to the risk of hemodynamic compromise and potential increase in right-to-left shunt.Case Presentation: We report the anaesthetic management of a 23-year-old female with an uncorrected ventricular septal defect and severe pulmonary hypertension undergoing craniotomy for cerebral abscess. A physiology-guided total intravenous anaesthesia (TIVA) technique using ketamine and dexmedetomidine, supplemented with bilateral scalp block and near-infrared spectroscopy (NIRS)-guided cerebral oxygenation monitoring, was employed. Intraoperative cerebral desaturation detected by NIRS was promptly corrected by oxygen and hemodynamic titration, resulting in a stable perioperative course.Conclusion: Ketamine–dexmedetomidine TIVA combined with NIRS-guided cerebral oxygen monitoring provides a safe and effective anaesthetic strategy for high-risk neurosurgical patients with cyanotic congenital heart disease. The approach results in stable hemodynamics, improved outcomes, and potentially reduced risk of adverse events.