Clinical case discussion: anesthesia for Cesarean section in a parturient with a large intrathoracic tumour

Purpose: To report the anesthetic management of a parturient with a large i ntrathoracic tumour, presenting for Cesarean section. Clinical features: A 28-yr-old parturient, gravida I, presented at 33 weeks gestation with a one month history of increasing cough and dyspnea. A comp uted tomography scan demonstrated a large mass filling the right hemothorax , causing mediastinal displacement to the left and carinal compression. Bot h mainstem bronchi were compressed and there was near total obliteration of the lumens of the right lobar bronchi. A decision was taken to expedite de livery to allow for staging and treatment of her disease and Cesarean secti on was scheduled. She was seen in consultation and prescribed oxygen by nas al prongs, dextromethorphan for cough and ranitidine the evening before and the morning of surgery. A subarachnoid block was performed and a block to the upper thoracic dermatomes was achieved; surgery proceeded uneventfully with the patient's head and upper body elevated about 15 degrees from the s upine. The patient was discharged to the medical oncology service for evalu ation and treatment. Conclusions: Intrathoracic tumour; are uncommon in pregnancy. The physiolog ical changes of pregnancy may mask not only the initial presentation but al so, even advanced intrathoracic disease. Regional anesthesia is the anesthe tic of choice and is rarely contraindicated by maternal condition.