P022: PERIOPERATIVE ANESTHESIA CONSIDERATIONS DURING SURGICAL RESECTION OF LARGE PERICARDIAL CYST
Oleg Desyatnikov, DO; Hani Murad, MD; Victor Iturbides, MD; HCA Florida Kendall Hospital
Background: Pericardial cysts affect only about 1 in 100,000 people, and typically only cause symptoms in approximately 25% of affected patients. In rare occasions the lesion could grow in size and could cause life threatening complications requiring interventions to drain the thin fluid-filled sac.
Case: A 57-year-old male with no significant past medical history presented to the cardiothoracic surgery clinic with a symptomatic large right pericardial cyst. After discussion of risks and benefits, the decision was made to proceed with robotic-assisted right pericardial cyst removal.
Results: The patient underwent a standard induction of general anesthesia with lidocaine, fentanyl, propofol, and succinylcholine. A double lumen endotracheal tube was placed under direct laryngoscopy and confirmed with auscultation of equal breath sounds bilaterally and capnography. No anesthesia complications were encountered throughout the perioperative period and the patient was extubated at the completion of the surgery.
Discussion: Although we present a case without anesthesia complications many preoperative considerations and evaluations were made in preparation. Depending on the size and location of the pericardial cyst a number of intrathoracic structures are susceptible to mechanical compression requiring forethought and preoperative management. Preoperative risk stratification also determines the anesthesia induction technique and precautions. Multi-disciplinary discussion should be held to ensure proper anesthesia technique to best visualize the surgical field during the procedure. Furthermore, close attention should be paid to the intraoperative cardiovascular and overall hemodynamic effects that a large pericardial cyst could have.