Background:Even though lung cancer in obstetric population has been increasing in the last years, it is still considered a rare entity, with very limited published experience on anaesthetic management.

Case Report:A 42-year-old pregnant woman at 30 + 4 weeks of gestation presented severe acute respiratory failure secondary to pulmonary embolism. She reported a four-week history of chest and back pain. After initial stabilization and anticoagulant therapy prescription, a diagnosis of stage IV ALK+ lung cancer was made. Diagnostic imaging studies showed a large mass in the left lung involving mediastinal elements,carcinomatous lymphangitis and brain, liver and bone metastases (dorsal, lumbar and sacral spine lesions). A multidisciplinary team of anesthesiologists, obstetricians, oncologists and neonatologists, decided to perform an elective caesarean section to improve the patient’s respiratory function and to start the chemotherapy treatment. 

The impossibility of performing a regional technique, led us to use general anaesthesia (GA) with invasive monitoring of blood pressure and cardiac output. Thiopental, fentanyl and rocuronium were chosen for a rapid sequence anaesthetic induction, and remifentanyl and propofol infusion for anaesthesia maintenance. We used protective ventilation without PEEP. The patient remained haemodynamically stable. Anaesthesia and surgery were uneventful.

Discussion:Our main challenge was to decide whether GA was the best posible option in this case considering the high hemodynamical, respiratory and neurological risk of our patient with the GA, but we had no choice because of the presence of spinal and brain metastases, that contraindicated the neuraxial techniques, the gold standard technique in cesarean sections in an expectant who presents with lung cancer.

References:1.C.L.Burlacu.Anaestheia for caesarean section in a woman with lung cancer:case report and review.Int J Obstet Anesth.2007 Jan;16(1):50-62

Learning points:Pregnancy complicated with lung cancer has been rarely reported and published anaesthesia data are limited, specially about GA. However, the incidence is now increasing. The management of a pregnant woman with advanced lung cancer should be planned with a multidisciplinary team.Regional anaesthesia is known to be the gold standard anaesthetic technique but is normally contraindicated with spinal and/or brain metastases. This condition requires a careful anaesthetic management

01 / ANAESTHETIC MANAGEMENT IN ADVANCED LUNG CANCER DURING PREGNANCY
Tébar Cuesta M.I., Valle Vidal E., Bellido López A., Lugo Duarte C., Pérez-Cerdá Silvestre F.
Department of Anaesthesia, 12 de Octubre Universitary Hospital, Madrid, Spain

01 / ANAESTHETIC MANAGEMENT IN ADVANCED LUNG CANCER DURING PREGNANCY Tébar Cuesta M.I., Valle Vidal E., Bellido López A., Lugo Duarte C., Pérez-Cerdá Silvestre F. Department of Anaesthesia, 12 de Octubre Universitary Hospital, Madrid, Spain