[Anesthetic management during removal of a giant intrathoracic mass]

We report the case of a young woman with a giant intrathoracic angiomyolipoma accounting for 10% of her weight and occupying 75% of the right hemithorax and 30% of the left. Before anesthetic induction, an arterial line and a central venous catheter were applied for monitoring; neck and thoracic punctures were avoided. The trachea was intubated with a double lumen tube after provision of sedation and analgesia with remifentanil-midazolam and topical anesthesia of the larynx. A rigid bronchoscope and extracorporeal circulation were available at all times and muscle relaxants were avoided. Ventilation was maintained with pressure support until the mass effect was resolved. The patient was transferred to the intensive care unit, extubated after 24 hours, and discharged 5 days after surgery. We describe the recommendations for perioperative management in cases involving this type of tumor and the complications that can develop. Recent symptoms, diagnostic images, and the results of lung function tests provide information for guiding the anesthetic approach. The obstructive ventilatory compromise caused by a giant mass depends more on location than size. Extracorporeal circulation or rigid bronchoscopy might be needed at any time during surgery.