Clinical case discussion: Anesthesia for Cesarean section in a parturient with a large intrathoracic tumour

Abstract

Purpose: To report the anesthetic management of a parturient with a large intrathoracic tumour, presenting for Cesarean section. Clinical features: A 28-yr-old parturient, gravida I, presented at 33 weeks gestation with a one month history of increasing cough and dyspnea. A computed tomography scan demonstrated a large mass filling the right hemothorax, causing mediastinal displacement to the left and carinal compression. Both mainstem bronchi were compressed and there was near total obliteration of the lumens of the right lobar bronchi. A decision was taken to expedite delivery to allow for staging and treatment of her disease and Cesarean section was scheduled. She was seen in consultation and prescribed oxygen by nasal prongs, dextromethorphan for cough and ranitidine the evening before and the morning of surgery. A subarachnoid block was performed and a block to the upper thoracic dermatomes was achieved; surgery proceeded uneventfully with the patient's head and upper body elevated about 15° from the supine. The patient was discharged to the medical oncology service for evaluation and treatment. Conclusions: Intrathoracic tumours are uncommon in pregnancy. The physiological changes of pregnancy may mask not only the initial presentation but also, even advanced intrathoracic disease. Regional anesthesia is the anesthetic of choice and is rarely contraindicated by maternal condition.