Anesthetic challenge in the aftermath of a Pandemic

Giant ovarian tumor (35 Kg)

Authors

  • Sofia Pereira Centro Hospitalar Tondela Viseu

DOI:

https://doi.org/10.25751/rspa.26619

Keywords:

Ovarian tumor, general anesthesia, Protective ventilation

Abstract

A 59y woman was scheduled for exploratory laparotomy to remove a giant ovarian neoplasm.  Medical history relevant to anemia (9 mg/dL) and coronary heart disease. In pre anesthetic consultation she reported short of breath (grade 1 in mMRC 1) and  functional capacity >4 METs. Physical examination relevant to peripheral edema and last transthoracic echocardiography with a normal ejection fraction (56%). Surgery was scheduled after gynecology, anesthesia and general surgery discussion. Balanced general anesthesia was conducted with a rapid sequence induction. Maintenance with sevoflurane,rocuronium e fentanyl 1,2. After endotracheal intubation, volume-controlled ventilation was setted to protective ventilation:  low tidal volumes and high respiratory rate (15-18).3 During surgery, peak inspiratory pressure (PICO) with 30 cmH2O was observed. She kept hemodynamically stable. After giant tumor resection (35kg) peak inspiratory pressure dropped,  and increased the mean arterial blood pressure  and urinary output. No major perioperative cardiorespiratory complications were observed, like pulmonary re-expansion.1,2

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References

- Akazawa, M; et al. Management of a Giant Ovarian Tumor More Than 30 kg: A Case Report and Review of the Literature. J. of Gynecologic Surgery. 2018; 34(5), 243–247.

- Güraslan H, Yaşar L, Ekin M, Kaya C, Cengiz H, Gonenc M. A successful management of a giant mucinous ovarian tumor with intraoperative controlled fluid aspiration. Eur J Gynaecol Oncol. 2015;36(5):615-7. PMID: 26513896.

- Hemmes SN, et al. High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial. Lancet. 2014 Aug;384(9942) 495-503.

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Published

2023-01-04

How to Cite

Pereira, S. (2023). Anesthetic challenge in the aftermath of a Pandemic: Giant ovarian tumor (35 Kg). Journal of the Portuguese Society of Anesthesiology, 31(1). https://doi.org/10.25751/rspa.26619

Issue

Vol. 31 No. 1 (2022): Revista da Sociedade Portuguesa de Anestesiologia

Section

Image in Anesthesiology

License

Copyright (c) 2022 Sofia Pereira

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