Abstract
A 70-year-old woman had been diagnosed with multiple system atrophy (MSA) at the age of 65 years and had been receiving treatment on an outpatient basis. She underwent a Hartmann surgical procedure for rectal cancer in February 2009. In April 2011, a partial resection was performed for a metastatic pulmonary tumor in the S3 region of the right lung. Although the endotracheal tube was removed immediately after the operation, reintubation was required the following day, because the patient had respiratory complications due to seesaw-like breathing and retained airway secretions. This tube was removed on postoperative day (POD) 3, and then inserted again when the patient demonstrated similar breathing difficulties. A tracheostomy was performed on POD9, with the patient weaned off ventilatory support on POD20 and discharged from the hospital on POD109. However, she died of respiratory failure at home on POD120. MSA is a sporadic neurodegenerative disease in which disturbances of the olivopontocerebellar, striatonigral, and autonomic nervous systems progress, with possible breathing disorders caused by a variety of mechanisms. To the best of our knowledge, there have been no previous investigations of thoracotomy procedures for MSA patients. In the present study, we report on precautions in the postoperative management of such cases.
