Anesthetic Management of Emergency Pneumonectomy for Massive Hemoptysis Secondary to Pulmonary Aspergilloma: A Case Report

Emergency pneumonectomy is a high-risk procedure reserved for life-threatening conditions when conservative management fails. The procedure carries substantial mortality rates, yet literature addressing specific anesthetic management strategies remains limited. We present a 65-year-old male with poorly controlled pulmonary tuberculosis who developed massive hemoptysis secondary to pulmonary aspergilloma. He experienced hemodynamic instability and cardiac arrest in the emergency department, was successfully resuscitated, and remained stable in the intensive care unit for three days. Following clinical deterioration with recurrent abundant hemoptysis, an emergent left pneumonectomy was performed. Our anesthetic management included early airway control with double-lumen intubation, comprehensive hemodynamic monitoring, goal-directed fluid therapy, lung-protective ventilation, and continuous paravertebral block for postoperative analgesia. Intraoperative challenges included significant bleeding requiring immediate lung isolation and vasoactive support with norepinephrine. The emergency left pneumonectomy was completed successfully without major complications. The patient required no strong opioid analgesics postoperatively, with pain management achieved through paravertebral block and occasional non-opioid systemic analgesics as needed. Hospital stay was 18 days with uncomplicated recovery and discharge home without respiratory, cardiovascular, or infectious complications. This case demonstrates that emergency pneumonectomy can be performed safely with favorable outcomes when appropriate perioperative protocols are implemented. Key success factors include rapid airway control with lung isolation, advanced hemodynamic monitoring, goal-directed fluid management, and multimodal analgesia. The described anesthetic approach may serve as a framework for managing similar emergency thoracic procedures.