title: Perioperative management of patients with lung carcinoma and cerebral metastases.
abstract: OBJECTIVE
  The present study proposes to present the importance of perioperative therapeutic management in survival prolongation and the quality of life for patients that have undergone surgery for cerebral metastases secondary to pulmonary tumors.
  
  
  METHODS
  During 2001-2009, 40 patients with ages between 43-74 years have been diagnosed in our clinic with pulmonary tumor and cerebral metastases. The patients presented single cerebral lesion (excepting one patient with 2 cerebral metastases) and pulmonary tumor. Intracranial pressure (ICP) was high in all cases. All patients have undergone operation with general anesthesia.
  
  
  RESULTS
  For all patients the reduction of ICP and keeping an optimal CPP (cerebral perfusion pressure) was pursued. In 38 cases, general anesthesia was performed with Sevoflurane and opioids (fentanyl, remifentanyl, sufentanyl) and in 2 cases the TIVA (total intravenous anesthesia) technique was used with propofol and remifentanyl. 14 of the patients required intraoperative depletive treatment through administering mannitol 20%. 37 patients (92%) have been discharged with improved neurological condition without showing signs of intracranial hypertension, convulsive seizures and with partially or totally remitted hemiparesis and one patient had worse postoperative neurological status.
  
  
  CONCLUSIONS
  Pulmonary tumor with cerebral metastases represent an important cause for death rate. To solve secondary cerebral lesions, the perioperative management must include assesment and choosing an anesthesia technique with a proper intraoperative management.
authors: ATI Department, "Prof. Dr. Bagdasar-Arseni" Emergency Clinical Hospital, Bucharest, Romania.
authors: Eva
authors: E
authors: Gheorghita
authors: Viorel Mihai
authors: VM
authors: Pruna
authors: Luminita
authors: L
authors: Neagoe
authors: Cristina
authors: C
authors: Bucur
authors: Catioara
authors: C
authors: Cristescu
authors: Mircea Radu
authors: MR
authors: Gorgan