Korean J Anesthesiol.  2008 Jul;55(1):114-118. 10.4097/kjae.2008.55.1.114.

Sinus arrest during valsalva maneuver after pneumonectomy: A case report

• Song JG
• Ryu K
• Kim SK

• KMID: 1782532
• DOI: http://doi.org/10.4097/kjae.2008.55.1.114

Abstract

We report a case of cardiac arrest in a 71 year old male during the Valsalva maneuver that had been performed immediately after completing a pneumonectomy. The patient had a subclinical atrial septal defect (1.08 cm sized) and he previously undergone a left upper lobectomy of the lung without complications 11 months earlier. He underwent a left completion pneumonectomy due to recurrent lung cancer. After surgery a Valsalva maneuver was performed with 35 cmH2O to relocate the mediastinum. During this procedure, the patient experienced a cardiac arrest and was resuscitated with difficulty. It is believed that the cardiac arrest was due to pulmonary hypertension, right ventricular failure and right to left shunt caused by several factors, such as the pneumonectomy, subclinical atrial septal defect (1.08 cm sized), and Valsalva maneuver. In addition, the hypovolemia caused by fluid restriction and the epidural injection of local anesthetics might have contributed to this incident. Although it is a rare complication, it is suggested that subclinical ASD can cause severe hypoxemia, dyspnea even cardiac arrest after pneumonectomy. In order to avoid these complications, ASD should be treated with percutaneous closure or surgical intervention. If these are not possible, care must be taken when anesthetizing the patient, and anything that can increase the pulmonary vascular resistance and right to left shunt should be avoided.

Keyword

ASD; cardiac arrest; pneumonectomy; right-to-left shunt

MeSH Terms

Anesthetics, Local
Anoxia
Dyspnea
Heart Arrest
Heart Septal Defects, Atrial
Humans
Hypertension, Pulmonary
Hypovolemia
Injections, Epidural
Lung
Lung Neoplasms
Male
Mediastinum
Pneumonectomy
Valsalva Maneuver
Vascular Resistance
Anesthetics, Local