title: Anesthetic considerations in Demons-Meigs' syndrome: a case report.
abstract: BACKGROUND
  Demons-Meigs' syndrome is characterized by the presence of a benign ovarian tumor associated with ascites and a right-sided hydrothorax. Its pathophysiology remains unclear. Anesthesia of this syndrome is a real challenge. Respiratory, hemodynamic, metabolic problems and abdominal hypertension are the main anesthetic risks.
  
  
  METHODS
  A 52-year-old African woman with Demons-Meigs' syndrome was admitted for elective surgery under general anesthesia. An abdominal computed tomography scan showed a tumor mass, with tissue and cystic components associated with abundant ascites and a right pleural effusion of medium abundance. In the operating room after standard monitoring, a crash induction was performed. Just after, her saturation level decreased requiring the use of an alveolar recruitment maneuver followed by the application of positive end-expiratory pressure. Vasoconstrictor and vascular filling were used to correct the hypotension that occurred. Airway pressures remained at 35 cm H2O. Maintenance of a slightly proclive position and opening of the abdomen with the progressive removal of 3200 ml ascitic fluid allowed a lower thoracic pressure (airway pressures=24 cm H2O). Her postoperative course was unremarkable. Clinical evolution after five months was marked by a complete recovery of our patient and no recurrence of effusion or ascites.
  
  
  CONCLUSIONS
  Demons-Meigs' syndrome is a benign disease with a good prognosis. Respiratory and hemodynamic problems and abdominal hypertension are the main anesthetic risks of this syndrome. Good management of these risks is necessary to preserve the prognosis.
authors.forename: Salaheddine
authors.initials: S
authors.lastname: Fjouji
authors.affiliation: Department of Anaesthesiology, Military Hospital Med V Rabat, University of Med V Souissi, Avenue des Nations Unies, Rabat 10000, Morocco. mustaphabens_15rea@hotmail.com.
authors.forename: Mustapha
authors.initials: M
authors.lastname: Bensghir
authors.forename: Charki
authors.initials: C
authors.lastname: Haimeur
authors.forename: Hicham
authors.initials: H
authors.lastname: Azendour
mesh_terms: D000768:Anesthesia, General / Q000379:methods*; D005260:Female; D006801:Humans; D008539:Meigs Syndrome / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged