title: [Anesthetic management for a patient with chronic expanding hematoma of the thorax associated with respiratory failure].
abstract: Chronic expanding hematoma (CEH) of the thorax is an intractable disease which induces long-standing growing hematoma after tuberculosis or thoracic surgery. It causes respiratory failure and heart failure by compressing the mediastinum. A 68-year-old man with a history of tuberculosis during childhood had suffered from progressive exertional dyspnea for 20 years. Because a huge hematoma occupying whole right thoracic cavity compressed the heart and the trachea to the left, he was scheduled for extrapleural pneumonectomy. Bronchial arterial embolization was performed preoperatively to prevent hemoptysis and reduce intraoperative blood loss. There was no problem in the airway management using a double lumen endotracheal tube. However, severe hypotension and a decrease in cardiac index were observed due to excessive bleeding, leading to total blood loss of 11,000 g. In addition, surgical manipulation caused abrupt severe hypotension. Monitoring of arterial pressure-based cardiac output and deep body temperature was useful for the hemodynamic management during the operation. The successful postoperative course resulted in remarkable improvement of Huge-Jones dyspnea criteria from IV to II. In the anesthetic management of CEH precautions should be taken against the excessive intraoperative bleeding and abrupt hemodynamic changes.
authors: Kenji
authors: K
authors: Kurotaki
authors: Akiko
authors: A
authors: Yoshida
authors: Yosuke
authors: Y
authors: Ito
authors: Kei
authors: K
authors: Nagaya
mesh_terms: D000368:Aged; D000777:Anesthetics; D002908:Chronic Disease; D006406:Hematoma / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D012131:Respiratory Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology*; D013909:Thorax; D014057:Tomography, X-Ray Computed
chemical_list: D000777:Anesthetics