Utility of the FloTrac™ Sensor for Anesthetic Management of Laparoscopic Surgery in a Patient After Pneumonectomy: A Case Report and Literature Review

Abstract

Patient: Female, 35-year-old Final Diagnosis: Left adrenal gland metastases • post right pneumonectomy for lung metastases • retroperitoneal angiosarcoma Symptoms: Dyspnea Medication: — Clinical Procedure: FloTrac™ sensor Specialty: Anesthesiology Objective: Unusual setting of medical care Background: Pneumonectomy is associated with various anatomical changes and potential complications involving the respiratory and cardiovascular systems. How laparoscopic surgery affects cardiorespiratory status in postpneumonectomy patients is yet to be ascertained. Here, we describe the use of the FloTrac™ sensor for the anesthetic management of laparoscopic adrenalectomy in a postpneumonectomy patient. Case Report: A 35-year-old woman underwent an extended hysterectomy and right pneumonectomy for retroperitoneal angiosarcoma and lung metastases, respectively. The metastasis was found in her left adrenal gland; therefore, laparoscopic adrenalectomy was scheduled. Spirometry demonstrated the following: forced vital capacity (FVC), 1.90 L (55.6% of predicted value); vital capacity, 53.6%; forced expiratory volume (FEV 1 ), 1.38 L (47.3% of predicted value); and FEV 1 /FVC, 72.4%. The heart and mediastinal structures had shifted into the right hemithorax. Hugh-Jones classification was grade 2. The induction of general anesthesia was planned. The patient was orotracheally intubated and managed with the pressure control ventilation-volume guaranteed mode of ventilation, targeting an expired tidal volume of 6–7 ml/kg, without using PEEP. We evaluated cardiac output (CO), cardiac index (CI), stroke volume (SV), and stroke volume variation (SVV) using a FloTrac™ sensor. After the establishment of pneumoperitoneum, SVV increased. CO and SV decreased slightly; however, the patient’s hemodynamic status was stable. After surgery, we extubated the patient in the operating room; she demonstrated good progress and was discharged home on postoperative day 5. Conclusions: We found changes in the values of SVV after pneumoperitoneum in a postpneumonectomy patient. The FloTrac™ sensor may be a minimally invasive and promising monitor for detecting hemodynamic changes associated with laparoscopic surgery in postpneumonectomy patients.

Anesthetic management of a huge retroperitoneal leiomyoma: a case report

“…Although overall limited agreement with reference CO determined by transpulmonary thermodilution was presented, the FloTrac™ system was still able to accurately track CO trending when preload changes or in normodynamic conditions (Meng et al 2011 ; Slagt et al 2014 ). Besides, SVV has proven reliable in predicting fluid responsiveness in mechanically ventilated patients, even at low tidal volumes (Alvarado Sanchez et al 2021 ; Cannesson et al 2009 ; Akazawa et al 2020 ). In our case, changes in CO were very sensitive to changes in venous return caused by manipulating the tumor or abrupt decrease in intra-abdominal pressure.…”