Anesthetic consideration in Meigs syndrome with large pleural effusion and lung collapse

Abstract

Meigs syndrome (MS) is characterized by a benign ovarian tumor (fibroma), hydrothorax on the right side, and ascites; which can be resolved permanently after surgery. Available literature reveals that most MS surgeries were performed under general anesthesia (GA)[1]. However, GA poses major risks to the patient. Considering the high risk of gastric content regurgitation, poor general condition or dyselectrolytemia may lead to delayed arousal, and associated multi-organ dysfunction. Intraoperative mechanical ventilation is also difficult due to ascites and hydrothorax (reduced cardiac output, impaired ventilation-perfusion in lungs causing hypoxia and hypercapnia)[1,2]. In this letter, we report a case of MS tumor resection under the subarachnoid block (SAB) to mitigate these issues and also review the complications associated with both techniques.

References

[1] Fjouji S, Bensghir M, Haimeur C, Azendour H. Anesthetic considerations in Demons—Meigs' syndrome: A case report. J Med Case Rep 2014; 8: 320.

[2] Donelly PB. Anaesthesia in Meig’s syndrome. Anaesthesia 1966; 21(2): 216-220.

[3] Krenke R, Maskey—Warzechowska M, Korczynski P, Zielinska—Krawczyk M, Klimiuk J, Chazan R, et al. Pleural effusion in Meigs' syndrome—transudate or exudate? Systematic review of the literature. Medicine (Baltimore) 2015; 94(49): e2114.

[4] Turan A, Bajracharya GR, Leung S, Yazici Kara M, Mao G, Botsford T, et al. Association of neuraxial anesthesia with postoperative venous thromboembolism after noncardiac surgery: A propensity—matched analysis of ACS—NSQIP Database. Anesth Analg 2019; 128(3): 494-501.