General anesthesia for giant tumor resection and facial reconstruction in a patient with atrial fibrillation, hypertension, heart valve diseases (Case report).

Abstract

General anesthesia for giant tumor resection and facial reconstruction in the elderly patients with atrial fibrillation, hypertension, and comorbidity valvular heart disease presents a major challenge for both anesthesiologists and surgeons in terms of the prevention and management of complications that may occur before, during, and after surgery.
A 74-year-old cachexia female suffered from a giant facial tumor compressing on the right eye, right nose, narrowing the left nasal cavity, growing into the palpate. She had atrial fibrillation, hypertension, comorbidity valvular heart disease. Before the surgery, she was received intravenous nutrition, maintained treatment of atrial fibrillation, hypertension, corrected electrolyte disturbances. She was scheduled to make complete resection of the tumor, skin flap reconstruction under endotracheal general anesthesia. She has inserted an endotracheal tube through a fiberoptic bronchoscope under sedation and analgesia. The hypotensive anesthesia was made by a combination of inhalational and intravenous anesthetics, analgesics, and esmolol intravenous infusion to manage intraoperative blood pressure.
Appropriate patient selection, optimal preoperative patient preparation, selection of appropriate anesthesia methods, close coordination with surgeons and cardiologists, careful monitoring, and timely management of intraoperative complications are decisive factors for successful surgical anesthesia in patients.