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Anesth Analg 2004;98:1160-1163
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000101982.75084.F2

OBSTETRIC ANESTHESIA

Perioperative Management with Epidural Anesthesia for a Parturient with Superior Vena Caval Obstruction

Asokumar Buvanendran, MD*, Pouya Mohajer, MD*, Xavier Pombar, MD{dagger}, and Kenneth J. Tuman, MD*

Departments of *Anesthesiology and {dagger}Obstetrics and Gynecology, Rush University Medical Center, Chicago, Illinois

Address correspondence and reprint requests to Asokumar Buvanendran, MD, Department of Anesthesiology, Rush Medical College, 1653 W. Congress Parkway, Chicago, IL 60612. Address e-mail to Asokumar{at}aol.com

Perioperative management of patients with superior vena cava obstruction presents an anesthetic challenge because of severe cardiopulmonary compromise. This is particularly important in the parturient because of increased upper airway edema and inferior vena caval compression. We describe the management of a parturient who presented at 34 wk of gestation with signs and symptoms of superior vena cava obstruction from metastatic breast cancer. The patient was scheduled for a cesarean delivery followed by chemotherapy, as other therapies were deemed excessively risky because of the anatomic characteristics of the large mediastinal mass. This report describes the successful use of regional anesthesia in this setting and discusses the relevant anesthetic and perioperative management considerations for this complex scenario.

IMPLICATIONS: Perioperative management of patients with superior vena caval obstruction presents an anesthetic challenge because of the severe cardiopulmonary compromise. This case report describes a parturient who presented for cesarean delivery with superior vena caval obstruction resulting from metastasis from breast cancer.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2004 by the International Anesthesia Research Society.