Complex Perioperative Decision-Making: Liver Resection in a
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Abstract :
The perioperative management of patients suffering from extensive superior vena cava (SVC) thrombus complicated by SVC syndrome presents unique challenges. The anesthesiologist needs to be prepared for possible thrombus dislodgement resulting in pulmonary embolism and also has to assess the need for fluid resuscitation given the dangers of massive intravenous fluid application via the upper extremities. We present our perioperative approach in management of a patient scheduled for right hepatectomy who was previously diagnosed with extensive SVC and right atrial (RA) thrombus complicated by SVC syndrome.

Case :
A 49-year-old female presented to the oncologic surgery service for right hepatectomy and wedge resection of segment 3 of the left lateral liver to remove four right hepatic lobe and one left hepatic lobe colon cancer metastases. Her past medical history was significant for sigmoid adenocarcinoma status after low anterior resection and four cycles of FOLFOX chemotherapy (leucovorin, 5-fluorouracil, and oxaliplatin) administered via a port-a-cath.....

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4745874/
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