Thoracic Cavity Irrigation: An Unusual Cause of Acute ST Segment Increase

Acute "Pseudoischemic" ECG Abnormalities after Right Pneumonectomy

New onset of electrocardiographic (ECG) abnormalities can occur after lung surgery due to the changes in the position of structures and organs in the chest cavity. The most common heart rhythm disorder is atrial fibrillation. So-called “pseudoischemic” ECG changes that mimic classic ECG signs of acute myocardial ischemia are also often noticed. We report the case of a 68-year-old male, with no prior cardiovascular disease, who underwent extensive surgical resection for lung cancer. On a second postoperative day, clinical and electrocardiographic signs of acute myocardial ischemia occurred. According to clinical course, diagnostic procedures, and therapeutic response, we excluded acute coronary syndrome. We concluded that physical lesion of the pericardium, caused by extended pneumonectomy with resection of the pericardium, provoked the symptoms and ECG signs that mimic acute coronary syndrome. Our final diagnosis was postpericardiotomy syndrome after extended pneumonectomy and further treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) was recommended. It is necessary to consider possibility that nature of ECG changes after extended pneumonectomy could be “pseudoischemic.”

Anesthetic strategies for patients undergoing extrapleural pneumonectomy

Anesthetic management of patients with extrapleural pneumonectomy may contribute to risk reduction, and it differs from management of patients with standard pneumonectomy in several respects. Hemodynamic and intravascular fluid management is complicated by the significantly greater blood loss and impairments of venous return imposed by weighty tumors and the blunt dissection process. There are greater risks of catastrophic (central) bleeding, dysrhythmias, cardiac herniation, and electrocardiographic changes. Restrictive forces increase the likelihood of dependent lung atelectasis during single-lung ventilation. Preoperative assessment of cardiopulmonary reserve remains an imprecise process. Awareness of these risks and limitations enables the anesthesiologist to understand, anticipate, and potentially preempt many intraoperative problems.