Extrapleural Pneumonectomy and Hyperthermic Intrathoracic Chemotherapy in Malignant Pleural Mesothelioma

REPORTentire pleural surface.Prominent mediastinal nodes in prevascular, pretracheal, aortopulmonary (AP) window, subcarinal, and left hilar region.EPP with HITHOC was planned.Patient was advised highprotein diet, chest physiotherapy, and nebulization with salbutamol and ipratropium bromide every 6 hours.After informed written consent, central line in the right internal jugular vein and thoracic epidural catheter was secured.Preop arterial blood gas analysis (ABGA) suggested pH 7.524, pO 2 64.4 mm Hg, pCO 2 32 mm Hg, and HCO 3 25.5 mmol/L.Monitor was applied for continuous invasive blood pressure (BP), pulse pressure variation (PPV), central venous pressure (CVP), nasopharyngeal temperature, peripheral capillary oxygen saturation (SpO 2 ), end-tidal carbon dioxide (EtCO 2 ), and ECG monitoring.After securing IV line, inj.glycopyrrolate 0.2 mg, inj.ranitidine, inj.ondansetron, inj.fentanyl 100 g, and antibiotics were given intravenously.After preoxygenation with 100% O 2 for 5 minutes, anesthesia was induced with inj.propofol 100 mg and inj.atracurium 30 mg intravenously.A 37 Fr right-sided double-lumen endotracheal tube (DLT) was placed, position confirmed with fiberoptic bronchoscopy and by auscultation.Anesthesia was maintained with oxygen, air, sevoflurane, and inj.atracurium.