title: [A case of a giant ovarian cyst anesthetized with the use of an inferior vena cava filter].
abstract: An intraperitoneal giant tumor can form deep venous thrombosis (DVT), leading to pulmonary embolism (PE) when it is removed. We report a case of a giant ovarian cystic tumor with possible DVT. A 52-year-old woman (149 cm in height, 85 kg in weight, and 150 cm in ventral girth) underwent the laparoscopic resection of the cyst. Preoperative angiography showed the obstruction of the inferior vena cava (IVC) just below the level of the right renal vein due to the compression by the tumor, and computed tomography suggested the existence of distal DVT. Anesthesia was induced with propofol and fentanyl, and the trachea was intubated using rocuronium. A permanent type IVC filter was placed near the obstruction site to prevent PE. Transesophageal echocardiography (TEE) was employed to detect the thrombotic echogram at the right atrium. Anesthesia was maintained with inhalation of sevoflurane and intravenous infusion of remifentanil. The content of the cyst (40.5 l) was suctioned slowly in about 50 min to avoid reexpansion pulmonary edema and circulatory collapse. Neither thrombotic echogram nor the acute decrease in end-tidal carbon dioxide pressure was observed throughout the anesthesia. Operation was performed uneventfully, and she recovered from anesthesia. We consider that IVC filters and TEE are useful to manage surgical patients with a huge ovarian cyst.
authors.affiliation: Department of Anesthesiology, Kurume University School of Medicine, Kurume 830-0011.
authors.forename: Naomitsu
authors.initials: N
authors.lastname: Kameyama
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Mishima
authors.forename: Shuhei
authors.initials: S
authors.lastname: Niiyama
authors.forename: Yohsuke
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Hisato
authors.initials: H
authors.lastname: Fukugasako
authors.forename: Kazuo
authors.initials: K
authors.lastname: Ushijima
mesh_terms: D000771:Anesthesia, Intravenous / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D010048:Ovarian Cysts / Q000601:surgery*; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000209:etiology