Challenges of Maintaining General Anesthesia in a Patient wi
Depending on the extent of tumor invasion, retroperitoneal tumor resection can become a complicated surgery entailing complex anesthesia management. Anesthesia management in such case is even more challenging when the patient has preexisting cardiac disease. We report the case of a 62-year-old man with compromised cardiac function who had recurrent sarcoma of the right retroperitonium with extensive invasion of surrounding tissue and who underwent radical en bloc resection of the inferior vena cava and aorta; L4 vertebrectomy; and right nephrectomy. Challenges in the patient’s anesthesia management included managing massive bleeding and maintaining hemodynamic stability during aorta clamping and unclamping. Aggressive perioperative medical management to optimize patient’s cardiac condition, careful planning of his intraoperative anesthetic management, and proactive communication among members of the anesthesia, surgery, nursing teams, and blood bank staff played critical roles in achieving the best possible outcome for the patient. This in-depth analysis of the case provides important insight that can be used to improve anesthesia management in similar cases.

In May 2013, a 62-year-old man undergoing serial surveillance computed tomography (CT) at our institution was found to have a large progressive retroperitoneal mass. The mass was identified as sarcoma, which measured 6x10 cm in size. The image showed that the tumor directly abutted and compressed the distal lumen of the inferior vena cava and appeared to be inseparable from the right iliac vessels and descending aorta and to encase the right ureter. The patient’s medical history included coronary artery disease (CAD), obesity, sleep apnea and anxiety. The patient consented to undergo radical resection of the tumor, L4 vertebrectomy, right nephrectomy, and resection and reconstruction of the major vessels....