Anesthesia Management in an Elderly Male with a Case of Adenocarcinoma Lung Posted for Right Lower Lobe Lobectomy: A Case Report

Abstract

Lobectomy with one-lung ventilation presents significant anesthetic challenges, particularly in elderly patients with multiple comorbidities. This case report describes the successful anesthetic management of an elderly patient with adenocarcinoma lung undergoing right lower lobe lobectomy. An elderly male with adenocarcinoma of the right upper lobe presented for lobectomy. His complex medical history included chronic kidney disease requiring regular hemodialysis, post-stroke right-sided hemiparesis, hypertension, hypothyroidism, and diabetes mellitus. The anesthetic management involved careful preoperative optimization, use of a left-sided double-lumen tube for one-lung ventilation, and meticulous hemodynamic monitoring. Challenges encountered included a brief episode of hypoxemia during one-lung ventilation and hypertension, which were successfully managed with ventilator adjustments and dexmedetomidine infusion, respectively. The six-hour surgery was completed successfully with minimal blood loss. The patient was extubated postoperatively and maintained stable oxygenation on supplemental oxygen. Pain management was achieved through multimodal analgesia, including a fentanyl patch. This case illustrates that complex thoracic surgery can be safely conducted in high-risk patients through comprehensive preoperative evaluation, careful intraoperative management, and adherence to enhanced recovery protocols. The successful outcome emphasizes the importance of a multidisciplinary approach in managing such challenging cases.