CASE 6 - 2014: Anesthetic management of thoracoscopic lobectomy in a patient with severe biventricular dysfunction

摘要

SURGICAL PATIENTS with dilated cardiomyopathy present a considerable challenge for perioperative management. Those undergoing pulmonary resection surgery are uniquely challenging. Effects of lung isolation and one-lung ventilation (OLV), patient positioning, and contraction of the pulmonary vascular bed may further complicate anesthetic management in patients with severe ventricular or biventricular dysfunction. Although general anesthesia and mechanical ventilation exert potentially profound effects on the cardiovascular system, these factors usually are well tolerated by patients with normal cardiovascular function. The perioperative management of patients with profound cardiac dysfunction undergoing thoracic surgery requires an especially thoughtful and informed approach. The authors review a case of a patient with severely impaired biventricular function who presented for pulmonary lobectomy and present a brief discussion of considerations for anesthetic management.