[Acute myocardial infarction in the postoperative period following pneumonectomy].
A 72-year-old man, smoker, with insuline-dependent diabetes and dislipemia underwent left pneumonectomy. Several episodes of intraoperative hemodynamic instability associated with electrocardiographic ST segment alterations were attributed to surgical manipulation; ischemia was not suspected. Cardiorespiratory failure, related to extensive anterior infarction, developed a few minutes after admission to the postoperative intensive care unit (PICU). Cardiopulmonary resuscitation and mechanical ventilation were required. The patient responded to treatment with beta blockers, platelet antiaggregants and statins. Tube was removed a few hours later and the patient was discharged from the PICU on the fifth day. Pneumonectomy has a high rate of morbidity and mortality, with complications mainly arising in the lung and heart. Risk from anesthesia is considered to be great in this procedure, and for that reason it is essential to identify intraoperative myocardial ischemia so that it can be treated aggressively. In patients at high cardiovascular risk who undergo lung resection, intraoperative episodes of myocardial ischemia are associated with a high incidence of postoperative miocardial infarction. Therefore, careful postoperative monitoring is needed and measures should be taken to prevent angina. Early extubation should be avoided.
López Alvarez
S
S
Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complejo Hospitalario Juan Canalejo, A Coruña. slopezal@wanadoo.es
Bonome González
C
C
Izquierdo Villarroya
B
B
Barbeito Vilariño
M J
MJ
Etxainz Alvarez
A
A
Alvarez Refojo
F
F
D000368:Aged; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy / Q000209:etiology*; D011013:Pneumonectomy / Q000009:adverse effects*