title: [Anesthetic management of a patient with squeezed heart by huge sternal tumor].
abstract: We experienced perioperative management for excision of a huge sternal chondrosarcoma squeezing the heart. A 46-year-old woman could not sleep due to dyspnea for 6 months. Dyspnea increased in the right decubitus and disappeared in the left decubitus. This suggested that the heart was squeezing the tumor. MRI and echocardiography revealed no invasion to the heart. Surgical removal was proposed. Anesthesia was induced with propofol and fentanyl. As this tumor composed of bone-like tissue and was tightly connected with thoracic cage, we thought that the use of muscle relaxant at the induction of anesthesia would not cause cardiovascular collapse and ventilation insufficiency even if the tumor was huge. Vecuronium was administered to facilitate endotracheal intubation. Hemodynamic variables were stable and mask ventilation was uneventful. Anesthesia was maintained with propofol, sevoflurane, supplemental dose of fentanyl and epidural anesthesia. The tumor had invaded the myocardium and was successfully flaked off from the myocardium without using any assisted devices. The tumor was excised including thoracic wall (sternum and parts of 3rd to 12th ribs, 20 cm in diameter). Thoracoplasty was performed using Marlex Mesh. Muscle relaxant was reversed after the end of the operation. Respiration was stable without flail chest. Endotracheal tube was successfully removed in the operation room. The postoperative course was uneventful.
authors.affiliation: Department of Anesthesiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511.
authors.forename: Mika
authors.initials: M
authors.lastname: Baba
authors.forename: Masashi
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Michioki
authors.initials: M
authors.lastname: Kuri
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Taniguchi
authors.forename: Tadanori
authors.initials: T
authors.lastname: Mammoto
authors.forename: Noriko
authors.initials: N
authors.lastname: Kanbara
authors.forename: Toshiko
authors.initials: T
authors.lastname: Sakai
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Kishi
mesh_terms: D000767:Anesthesia, Epidural; D000768:Anesthesia, General / Q000379:methods*; D001859:Bone Neoplasms / Q000473:pathology / Q000601:surgery*; D002813:Chondrosarcoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D006338:Heart Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007442:Intubation, Intratracheal; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011312:Pressure; D015742:Propofol; D013249:Sternum; D013526:Surgical Mesh; D014673:Vecuronium Bromide
chemical_list: D014673:Vecuronium Bromide; D015742:Propofol