International Journal of Cardiovascular ResearchISSN: 2324-8602

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Case Report, Int J Cardiovasc Res Vol: 1 Issue: 4

Anesthetic Management of Craniotomy for a Patient with a Large Right Atrial Tumor

Alaa A Abd-Elsayed1, Yuriy Estrin2, Sonia Saini3, Robert J. Weil4 and Ehab Farag5*
1Anesthesiology, University of Cincinnati, Cincinnati, Ohio, USA
2The Department of Regional Anesthesia, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
3The Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
4The Brain Tumor & Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
5The Department of General Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
Corresponding author : Ehab Farag, M.D
F.R.C.A., Department of General Anesthesiology/ E31 Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195,USA
Tel: (216) 444-7550; Fax: (216) 444-2294
E-mail: [email protected]
Received: September 24, 2012 Accepted: October 17, 2012 Published: October 25, 2012
Citation: Abd-Elsayed AA, Estrin Y, Saini S, Weil RJ, Farag E (2012) Anesthetic Management of Craniotomy for a Patient with a Large Right Atrial Tumor. Int J Cardiovasc Res 1:4. doi:10.4172/2324-8602.1000108

Abstract

Anesthetic Management of Craniotomy for a Patient with a Large Right Atrial Tumor

Introduction: We present the successful management of a unique case presented with hemorrhagic metastatic brain melanoma associated with a big metastatic mass in the right atrium.

Case presentation: A 68 year old man with recurrent melanoma of the chest wall presented for an emergent craniotomy for a hemorrhagic metastatic brain lesion. A large right atrial mass was found during his neurological workup. General anesthesia with etomidate induction, isoflurane and remifentanil maintenance was conducted. A central venous catheter was placed and position was confirmed using fluoroscopy. Preload optimization and neutral head position led to adequate cardiac output maintenance without increasing intracranial pressure. Immediate extubation was done following the surgery and the patient was discharged home on the fifth postoperative day after improvement of his neurological symptoms.

Conclusion: We presented a unique case with bleeding metastatic brain melanoma associated with right atrial secondary tumor. The anesthetic management was very challenging. Preload optimization and neutral head positioning were the key measures for managing this patient.

Keywords: Heart neoplasm; Craniotomy; Anesthesia

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