Tachi Keitaro, Inomata Shinichi, Tanaka Makoto
Department of Anesthesiology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
JA Clin Rep. 2019 Feb 28;5(1):15. doi: 10.1186/s40981-019-0235-0.
Primary pulmonary arterial sarcoma (PPAS) is a rare condition. Although resection is recommended to improve prognosis, optimal anesthesia management for these cases remains unclear.
A 62-year-old woman with a diagnosis of left pulmonary PPAS underwent surgical tumor resection and left lung pneumonectomy. Preoperative symptoms included a cough and hemoptysis. Computed tomography revealed a complete obstruction of the left pulmonary artery, with tumor extension into the right pulmonary artery, and mild tricuspid regurgitation was observed on the echocardiogram. Ninety minutes after anesthesia induction, the patient went into cardiopulmonary arrest. As the surgical field was sterilized, we proceeded with emergent sternotomy and cardiac massage. Extracorporeal circulation was established, and surgery proceeded once spontaneous circulation was recovered. The patient survived without neurological complications.
Based on our experience and in the absence of evidence-based guidelines, the femoral artery and vein should be cannulated in all cases for extracorporeal circulation initiation before anesthesia induction.
原发性肺动脉肉瘤（PPAS）是一种罕见疾病。尽管建议进行手术切除以改善预后，但此类病例的最佳麻醉管理仍不明确。
一名62岁女性被诊断为左肺PPAS，接受了肿瘤手术切除及左肺全肺切除术。术前症状包括咳嗽和咯血。计算机断层扫描显示左肺动脉完全阻塞，肿瘤延伸至右肺动脉，超声心动图显示轻度三尖瓣反流。麻醉诱导90分钟后，患者发生心肺骤停。由于手术区域已消毒，我们紧急进行胸骨切开术并进行心脏按压。建立体外循环，自主循环恢复后继续手术。患者存活且无神经并发症。
根据我们的经验，在缺乏循证指南的情况下，所有病例均应在麻醉诱导前经股动静脉插管启动体外循环。
