Alaa A Abd-Elsayed, Yuriy Estrin, Sonia Saini, Robert J. Weil and Ehab Farag
Anesthetic Management of Craniotomy for a Patient with a Large Right Atrial Tumor
Introduction: We present the successful management of a unique case presented with hemorrhagic metastatic brain melanoma associated with a big metastatic mass in the right atrium.
Case presentation: A 68 year old man with recurrent melanoma of the chest wall presented for an emergent craniotomy for a hemorrhagic metastatic brain lesion. A large right atrial mass was found during his neurological workup. General anesthesia with etomidate induction, isoflurane and remifentanil maintenance was conducted. A central venous catheter was placed and position was confirmed using fluoroscopy. Preload optimization and neutral head position led to adequate cardiac output maintenance without increasing intracranial pressure. Immediate extubation was done following the surgery and the patient was discharged home on the fifth postoperative day after improvement of his neurological symptoms.
Conclusion: We presented a unique case with bleeding metastatic brain melanoma associated with right atrial secondary tumor. The anesthetic management was very challenging. Preload optimization and neutral head positioning were the key measures for managing this patient.
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