Hemodynamic collapse induced by general anesthesia in a patient with an unruptured thoracic aortic aneurysm: a case report

BACKGROUND: Compression of the trachea, bronchi, and pulmonary arteries are complications in patients with large thoracic aortic aneurysms. In this case, we report unexpected cardiopulmonary collapse manifested by general anesthesia before surgery in an asymptomatic patient with a large thoracic aortic aneurysm. CASE PRESENTATION: We present the case of a 32-year-old man with a 10-cm aneurysm in the ascending aorta. A total aortic arch replacement was planned. After intravenous anesthesia, his aneurysm occluded the left main bronchus and right pulmonary artery simultaneously, and induced severe hypoxia. Percutaneous cardiopulmonary support was conducted and the patient recovered from cardiopulmonary collapse successfully. After the patient regained consciousness from anesthesia, the findings of organ compressions disappeared. At the second surgery, percutaneous cardiopulmonary support was initiated with local anesthesia before general anesthesia and intubation. The operation was performed successfully without any adverse events. CONCLUSION: We experienced a case of hemodynamic collapse induced by general anesthesia in a patient of an unruptured thoracic aortic aneurysm. It is important to recognize that fatal organ compression might be caused by general anesthesia even in asymptomatic patients with thoracic aortic aneurysm.