International Journal of Case Reports and Images - IJCRI - Case Reports, Case Series, Case in Images, Clinical Images

   
Case Report
 
A huge ovarian tumor: Perioperative ventilation challenges
Wan Fadzlina Wan Muhd Shukeri1, Wan Mohd Nazaruddin Wan Hassan2
1MBBCHBAO, M.MED (Anaesthesiology), Anaesthesiologist and lecturer, Department of Anaesthesia and Intensive Care Unit, School of Medical Sciences, Science University of Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
2MD, M.MED (Anaesthesiology), Consultant anaesthesiologist and senior lecturer, Department of Anaesthesia and Intensive Care Unit, School of Medical Sciences, Science University of Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

Article ID: Z01201603CR10620WS
doi:10.5348/ijcri-201633-CR-10620

Address correspondence to:
Wan Fadzlina Wan Muhd Shukeri
Department of Anaesthesia and Intensive Care Unit, School of Medical Sciences
16150 Kubang Kerian
Kelantan
Malaysia

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How to cite this article
Shukeri WFWM, Hassan WMNW. A huge ovarian tumor: Perioperative ventilation challenges. Int J Case Rep Images 2016;7(3):190–194.


Abstract
Introduction: Huge ovarian tumors can compromise respiratory functions in various ways leading to a challenging ventilation management.
Case Report: We report a case of a young lady with a huge ovarian tumor (17 kg) posted for tumor resection, which was initially intubated and required high ventilator setting using airway pressure release ventilation (APRV) mode in the intensive care unit (ICU) for respiratory failure secondary to concomitant splinting of diaphragm, pleural effusion and pneumonia. Herein, we described our successful use of APRV extended into the intraoperative period of the tumor resection in order to maintain an adequate oxygenation and ventilation. As the operating room (OR) ventilator is not equipped with APRV as a mode of ventilation, there were several practical challenges we faced. Firstly, we had to transport the ICU ventilator to the OR with the patient. Due to the inability to deliver inhaled anesthetic while the patient was connected to the ICU ventilator, and also to accommodate the need of spontaneous breathing with the use of APRV, we had to modify our usual anesthetic technique. We used total intravenous anesthesia in the form of propofol-remifentanil target-controlled infusion for maintenance of anesthesia and avoided the use of neuromuscular blocking agent. Her oxygenation markedly improved after the tumor was removed, and she was successfully extubated five days after the surgery.
Conclusion: In the case of a huge ovarian tumor with severe respiratory failure that requires APRV mode of ventilation preoperatively, the surgery for tumor resection can be proceeded successfully with the continuation of APRV into the intraoperative period. Based on our experience, we believe that this approach can also be applied in other types of huge intra-abdominal tumors which present with similar respiratory complications.

Keywords: Airway pressure release ventilation, Huge ovarian tumor, Total intravenous anesthesia


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Author Contributions
Wan Fadzlina Wan Muhd Shukeri – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Wan Mohd Nazaruddin Wan Hassan – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Wan Fadzlina Wan Muhd Shukeri et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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