麻酔導入後に循環虚脱を来した肺動脈肉腫摘出術の一例

抄録

Pulmonary artery sarcoma is a rare neoplasm with poor prognosis. Surgical resection may be performed, but the fatal hemodynamic collapse can occur during anesthesia induction. Case: A 70-year-old man felt dyspnea 3 months before the surgery. The space-occupying lesion in the pulmonary trunk was found, but his hemodynamics was maintained with 0.5 µg/kg/min of dobutamine, and the NYHA functional class was III. During induction of anesthesia, his hemodynamics collapsed, and the VA-ECMO (veno-arterial extracorporeal membrane oxygenation) was applied. The operation was performed, but the VA-ECMO was needed to maintain his hemodynamics after cardiopulmonary bypass, and he died on post-operative day 7. Prediction of hemodynamic collapse preoperatively is difficult. Therefore, the choice of anesthetic agents should be considered which would not change the systemic vascular resistance like ketamine. And also, noradrenaline should be used to maintain systemic vascular resistance and prevent hemodynamic collapse. Moreover, sheaths should be placed before induction of anesthesia so that VA-ECMO can be installed immediately when hemodynamic collapse occurs.