[Anesthetic management for surgery of patients with metastatic brain tumors associated with lung tumors].

We had four patients who received anesthesia for metastatic brain tumors. All patients were complicated with primary lung tumors which had caused several respiratory problems. Respiratory failure and intratracheal hemorrhage from lung tumors were the severest complications during and after the operation. Two patients suffered from pneumonia at early postoperative stage and died of respiratory failure within eighty days after the operation. We consider that these preoperative findings of atelectasis and hemosputum are important signs that could predict those severe complications. To avoid postoperative respiratory complications in patients with atelectasis, the anesthetist should perform careful perioperative management such as active preoperative pulmonary physical therapy and should choose anesthetics which do not affect postoperative consciousness and respiration, and should perform intensive postoperative respiratory care. To prevent pulmonary hemorrhage, the fiberoptic bronchoscopy is useful for the diagnosis and the therapy. We also consider that the long operation aggravates postoperative complications. Planning of operation and performing operative procedure in a shortest time possible are also important.