Anesthetic strategies for patients undergoing extrapleural pneumonectomy

Anesthetic management of patients with extrapleural pneumonectomy may contribute to risk reduction, and it differs from management of patients with standard pneumonectomy in several respects. Hemodynamic and intravascular fluid management is complicated by the significantly greater blood loss and impairments of venous return imposed by weighty tumors and the blunt dissection process. There are greater risks of catastrophic (central) bleeding, dysrhythmias, cardiac herniation, and electrocardiographic changes. Restrictive forces increase the likelihood of dependent lung atelectasis during single-lung ventilation. Preoperative assessment of cardiopulmonary reserve remains an imprecise process. Awareness of these risks and limitations enables the anesthesiologist to understand, anticipate, and potentially preempt many intraoperative problems.