Extrapleural pneumonectomy - Perioperative anaesthetic conduct

Abstract

Malignant mesothelioma is a rare tumour arising from mesothelial lining that mostly occurs in the pleura with survival of around 12 months.1 Extrapleural pneumonectomy, which is the mainstay of treatment for locally advanced malignant pleural mesothelioma, presents a great challenge to anaesthesiologists as it can be associated with high perioperative morbidity and mortality. We present a case report on anaesthetic management for extrapleural pneumonectomy in a 64-year-old patient with advanced malignant pleura mesothelioma. Our case report highlights: crucial role of anaesthetic management in reducing perioperative complications by better knowledge of physiology and technical aspects of the surgery; issues and challenges related to the anaesthetic management such as invasive monitoring, lung isolation, protective lung ventilation strategy, appropriate fluid management and adequate analgesia to enable extubation post-surgery in the operating room; high vigilance for diagnosing life-threatening complications such as cardiac herniation; team working and collaboration with surgeon to improve patient outcome and post-operative monitoring and management.