Intractable hypotension caused by acute superior vena cava obstruction after lung cancer surgery: a case report

Abstract The purpose of this case report is to inform other anesthesiologists about the identification, judgment, and management of sudden severe refractory hypotension in resuscitation after right pneumonectomy. We present a patient who underwent right lung and mediastinal lymph node resection. When the patient recovered from anesthesia, due to the change of position, the mediastinal free tissue entered the space and pressed on the superior vena cava (SVC), resulting in complete obstruction of the SVC and causing severe intractable hypotension. A 48-year-old man with bronchial lung cancer developed severe hypotension while preparing to recover from open-chest surgery under general anesthesia combined with intraspinal anesthesia. There was no response to rapid dilatation, fluid replacement, or treatment with drugs that could raise blood pressure (such as ephedrine, norepinephrine, and deoxyadrenalin). Since early symptoms of acute SVC syndrome in general combined epidural anesthesia were similar to those of severe anaphylaxis, general spinal anesthesia, hemorrhagic shock, pulmonary embolism, and pericardial tamponade, it was difficult to make judgments. A second thoracic operation was performed to remove the remaining tissue that caused the compression, ultimately making a successful recovery. Severe hypotension induced by acute SVC obstruction may trigger and aggravate brain edema and other complications if we cannot quickly identify the patient or administer traditional treatment (upper limb or internal jugular vein dilation and fluid replacement). Given the risk of disease deterioration, immediate identification of the cause of intractable hypotension is crucial.