Extrapleural pneumonectomy- perioperative anaesthetic conduct

Malignant mesothelioma is a rare tumour arising from mesothelial lining that mostly occurs in the pleura with survival of around 12 months. 1 Extrapleural pneumonectomy, which is the mainstay of treatment for locally advanced malignant pleural mesothelioma, presents a great challenge to anaesthesiologists as it can be associated with high perioperative morbidity and mortality. We present a case report on anaesthetic management for extrapleural pneumonectomy in a 64-year-old patient with advanced malignant pleura mesothelioma. Our case report highlights: crucial role of anaesthetic management in reducing perioperative complications by better knowledge of physiology and technical aspects of the surgery; issues and challenges related to the anaesthetic management such as invasive monitoring, lung isolation, protective lung ventilation strategy, appropriate fluid management and adequate analgesia to enable extubation post-surgery in the operating room; high vigilance for diagnosing life-threatening complications such as cardiac herniation; team working and collaboration with surgeon to improve patient outcome and post-operative monitoring and management.