A patient with a huge posterior mediastinal tumor and ST-segment depression in electrocardiogram

A 68-year-old woman had felt a chest and back pain for 3 months. Gradually her symptom became aggravated, and she felt severe dyspnea in supine position and dysphagia combined with superior vena cava syndrome. A huge posterior mediastinal tumor was revealed and her esophagus was severely narrowed on...

Full description

Saved in:
Bibliographic Details
Published inMasui. The Japanese journal of anesthesiology Vol. 53; no. 8; p. 914
Main Authors Namiki, Masanobu, Kita, Asuka, Kokita, Naohiro, Ichimiya, Takahiro, Namiki, Akiyoshi
Format Journal Article
LanguageJapanese
Published Japan 01.08.2004
Subjects
Aged
Airway Obstruction - prevention & control
Anesthesia, General
Cardiopulmonary Bypass
Electrocardiography
Female
Humans
Intraoperative Complications - prevention & control
Liposarcoma - surgery
Mediastinal Neoplasms - surgery
Monitoring, Intraoperative
Perioperative Care
Posture - physiology
Shock - prevention & control
Online AccessGet more information

Cover

More Information
Summary:A 68-year-old woman had felt a chest and back pain for 3 months. Gradually her symptom became aggravated, and she felt severe dyspnea in supine position and dysphagia combined with superior vena cava syndrome. A huge posterior mediastinal tumor was revealed and her esophagus was severely narrowed on the chest MRI. Therefore, emergency tumor resection was scheduled under general anesthesia. Anesthesia was induced by midazolam (2 mg) with the patient in the right lateral position. After gas exchange and oxygenation were comfirmed by pulse oximetry reading and clinical signs, she was slowly turned to supine position. But, suddenly, ST-segment depression and low amplitude developed in electrocardiogram and systolic blood pressure was depressed to below 60 mmHg. Therefore, she was rapidly retuned to right lateral position, and ST-segment and systolic blood pressure recoverd. On the next time, although she was slowly turned to the right semi-lateral position, there was almost no circulatory failure. A bronchial tube was intubated in her left bronchia under bronchoscope. We should remember that the preparation of percutaneous cardiopulmonary support (PCPS) should be considered as a means of protection against cardiovascular collapse or airway obstruction perioperatively.
ISSN:0021-4892