[The specific features of anesthesiological provision of operations removing malignant neoplasms with a tumorous thrombus in the inferior cava vein].
The paper presents the experience gained in performing 100 operations associated with removal of intravascular malignant tumors [tumorous thrombi (TT)] from the inferior cava vein (ICV), which were made without using artificial and assisted circulation. This approach is substantiated. The variants of TT extent and its associated surgical technical features are shown. The procedure developed by the authors for anesthesia and infusion therapy in performing these highly specific interventions is described. The postoperative period ran with complications in 27 patients: pulmonary thromboembolism (PTE) (n=6); pneumonia (n=5); acute renal failure (n=4); encephalopathy (4); acute pancreatitis (n=4); cardiac arrhythmia (n=4); hepatic failure (n=2); adult respiratory distress syndrome (n=2); sepsis with evolving multiple organ deficiency (n=1), gastrointestinal hemorrhage (n=2); intestinal paresis (n=1); ICV thrombosis (n=1); recurrent myocardial infarction (n=1). Intraoperatively, 3 patients died from massive PTE (n=1) and hemorrhage (n=2). In the early postoperative period, 2 patients died from hemorrhage and hypovolemic shock (n=1) and recurrent myocardial infarction (n=1). Two patients died from pyoseptic complications on days 11 and 35. Thus, the vast majority of patients successfully tolerate a surgical intervention when certain conditions (the stepwise design of an anesthesia scheme keeping in mind the specific features of the course of an operation, hemodynamic and laboratory monitoring, adequate venous access, efficient infusion-transfusion therapy, timely use of cardiovascular stimulants, use of intraoperative hardware reinfusion of autoerythrocytes) are met.
Gorbets
E S
ES
Feoktistov
P I
PI
D000768:Anesthesia, General / Q000379:methods*; D006502:Budd-Chiari Syndrome / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019043:Vascular Neoplasms / Q000150:complications / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*