Abstract
A 49-year-old man with trisomy 21 and Eisenmenger's syndrome presented for hip arthroplasty. Eisenmenger's syndrome is defined by the presence of obstructive pulmonary vascular disease secondary to long-standing left-to-right shunt causing pulmonary hypertension, eventually leading to shunt reversal in to right-to-left direction. Patients with Eisenmenger's syndrome pose a significant perioperative risk because of the physiological alterations induced by anaesthetic agents. The choice of anaesthetic technique in these patients is therefore not straightforward. A successful outcome was achieved with general anaesthesia supplemented with nerve blocks.