[Anesthesia for a patient with superior vena cava syndrome]

An 18-year-old male with a history of surgery to correct partial drainage of the pulmonary veins had been experiencing symptoms of superior vena cava syndrome (SVCS) for 2 years. Severe obstruction of the superior vena cava where it joined the right atrium became evident upon cardiac catheterization. Because the catheter could not be inserted into the atrium, angioplasty was ruled out and surgery was scheduled. Surgery was performed with the patient in Fowler's position. Electrocardiographic signals, oxygen saturation (pulse oximetry), temperature, bispectral index, diuresis, and invasive arterial pressure were monitored. A large vein was catheterized in the left foot, and a central venous catheter was inserted through the right femoral vein. Balanced anesthesia without nitrous oxide was provided, and a right axillary artery-inferior vena cava cardiopulmonary bypass was established. Once the defect was repaired, central venous pressure became normal and edema in the upper thoracic region decreased. Anesthesia for surgical correction of SVCS carries considerable risk related to such events as difficult intubation and ventilation, bleeding, and vessel collapse. Extreme precautions must be taken and certain procedures followed in order to avoid life-threatening complications.