{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T04:04:58Z","timestamp":1782965098872,"version":"3.54.5"},"reference-count":56,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,2,26]],"date-time":"2024-02-26T00:00:00Z","timestamp":1708905600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Romanian National Ministry of Research, Innovation and Digitalization","award":["PN-III-P4-ID-PCE-2020-1118"],"award-info":[{"award-number":["PN-III-P4-ID-PCE-2020-1118"]}]},{"name":"Romanian National Ministry of Research, Innovation and Digitalization","award":["PCE 225\/2021"],"award-info":[{"award-number":["PCE 225\/2021"]}]},{"name":"European Economic Space between Romania and Iceland 2021\u20132023","award":["PN-III-P4-ID-PCE-2020-1118"],"award-info":[{"award-number":["PN-III-P4-ID-PCE-2020-1118"]}]},{"name":"European Economic Space between Romania and Iceland 2021\u20132023","award":["PCE 225\/2021"],"award-info":[{"award-number":["PCE 225\/2021"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Due to a lack of randomised controlled trials and guidelines, and only case reports being available in the literature, there is no consensus on how to approach anaesthetic management in patients with giant intraabdominal tumours. Methods: This study aimed to evaluate the literature and explore the current status of evidence, by undertaking an observational research design with a descriptive account of characteristics observed in a case series referring to patients with giant intraabdominal tumours who underwent anaesthesia. Results: Twenty patients diagnosed with giant intraabdominal tumours were included in the study, most of them women, with the overall pathology being ovarian-related and sarcomas. Most of the patients were unable to lie supine and assumed a lateral decubitus position. Pulmonary function tests, chest X-rays, and thoracoabdominal CT were the most often performed preoperative evaluation methods, with the overall findings that there was no atelectasis or pleural effusion present, but there was bilateral diaphragm elevation. The removal of the intraabdominal tumour was performed under general anaesthesia in all cases. Awake fiberoptic intubation or awake videolaryngoscopy was performed in five cases, while the rest were performed with general anaesthesia with rapid sequence induction. Only one patient was ventilated with pressure support ventilation while maintaining spontaneous ventilation, while the rest were ventilated with controlled ventilation. Hypoxemia was the most reported respiratory complication during surgery. In more than 50% of cases, there was hypotension present during surgery, especially after the induction of anaesthesia and after tumour removal, which required vasopressor support. Most cases involved blood loss with subsequent transfusion requirements. The removal of the tumor requires prolonged surgical and anaesthesia times. Fluid drainage from cystic tumour ranged from 15.7 L to 107 L, with a fluid extraction rate of 0.5\u20132.5 L\/min, and there was no re-expansion pulmonary oedema reported. Following surgery, all the patients required intensive care unit admission. One patient died during hospitalization. Conclusions: This study contributes to the creation of a certain standard of care when dealing with patients presenting with giant intraabdominal tumour. More research is needed to define the proper way to administer anaesthesia and create practice guidelines.<\/jats:p>","DOI":"10.3390\/jcm13051321","type":"journal-article","created":{"date-parts":[[2024,2,26]],"date-time":"2024-02-26T07:51:39Z","timestamp":1708933899000},"page":"1321","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Anaesthesia Management for Giant Intraabdominal Tumours: A Case Series Study"],"prefix":"10.3390","volume":"13","author":[{"given":"Olga","family":"Gr\u0103jdieru","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Petri\u0219or","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantin","family":"Bodolea","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciprian","family":"Tomuleasa","sequence":"additional","affiliation":[{"name":"Department of Hematology, Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8292-911X","authenticated-orcid":false,"given":"C\u0103t\u0103lin","family":"Constantinescu","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.20892\/j.issn.2095-3941.2016.0084","article-title":"Epidemiology of ovarian cancer: A review","volume":"14","author":"Reid","year":"2017","journal-title":"Cancer Biol. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"862944","DOI":"10.3389\/fonc.2022.862944","article-title":"Tumor Size Is an Independent Prognostic Factor for Stage I Ovarian Clear Cell Carcinoma: A Large Retrospective Cohort Study of 1000 Patients","volume":"12","author":"Wu","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1308\/003588406X130651","article-title":"Size Matters for Sarcomas!","volume":"88","author":"Grimer","year":"2006","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.ejso.2020.02.012","article-title":"Appendiceal tumours and pseudomyxoma peritonei: Literature review with PSOGI\/EURACAN clinical practice guidelines for diagnosis and treatment","volume":"47","author":"Govaerts","year":"2021","journal-title":"Eur. J. Surg. Oncol. (EJSO)"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1001\/jama.2020.7840","article-title":"Perioperative Cardiovascular Risk Assessment and Management for Noncardiac Surgery: A Review","volume":"324","author":"Smilowitz","year":"2020","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1097\/MCC.0000000000000555","article-title":"Perioperative management of obese patient","volume":"24","author":"Bazurro","year":"2018","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.chest.2017.07.023","article-title":"Intraabdominal Hypertension, Abdominal Compartment Syndrome, and the Open Abdomen","volume":"153","author":"Rogers","year":"2018","journal-title":"Chest"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1097\/MCC.0000000000000701","article-title":"Evaluation and management of intraabdominal hypertension","volume":"26","author":"Allen","year":"2020","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.bjae.2021.01.002","article-title":"The cardiovascular effects of positive pressure ventilation","volume":"21","author":"Corp","year":"2021","journal-title":"BJA Educ."},{"key":"ref_10","first-page":"205","article-title":"Reexpansion pulmonary edema","volume":"14","author":"Sohara","year":"2008","journal-title":"Ann. Thorac. Cardiovasc. Surg. Off. J. Assoc. Thorac. Cardiovasc. Surg. Asia."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.1111\/j.1525-1438.2006.00745.x","article-title":"Giant ovarian cysts: Is a pre- and intraoperative drainage an advisable procedure?","volume":"16","author":"Einenkel","year":"2006","journal-title":"Int. J. Gynecol. Cancer Off. J. Int. Gynecol. Cancer Soc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1007\/BF03019231","article-title":"Same day drainage and removal of a giant ovarian cyst","volume":"44","author":"Nishiyama","year":"1997","journal-title":"Can. J. Anaesth."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1111\/j.1447-0756.1999.tb01162.x","article-title":"A case of huge ovarian cyst of 21-year-old young woman","volume":"25","author":"Kim","year":"1999","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1007\/s00345-005-0009-3","article-title":"Intra-operative inferior vena cava syndrome in a patient with autosomal dominant polycystic kidney disease","volume":"24","author":"Pierre","year":"2006","journal-title":"World J. Urol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/j.1447-0756.2007.00487.x","article-title":"Giant ovarian cancer weighing 100 kg with poor prognosis","volume":"33","author":"Yanazume","year":"2007","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1111\/j.1447-0756.2007.00711.x","article-title":"Giant abdominal tumor of the ovary","volume":"34","author":"Ueda","year":"2008","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s10397-010-0593-0","article-title":"Giant ovarian cystadenoma weighing 59 kg","volume":"8","author":"Fobe","year":"2011","journal-title":"Gynecol. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1097\/AOG.0b013e3182073af8","article-title":"Surgical removal of a gigantic abdominal mass: A multidisciplinary approach","volume":"117","author":"Kincey","year":"2011","journal-title":"Obstet. Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1186\/2193-1801-2-487","article-title":"Anesthetic management of a patient with a giant ovarian tumor containing 83 L of fluid","volume":"2","author":"Bamba","year":"2013","journal-title":"SpringerPlus"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.gynor.2013.05.001","article-title":"Complete resection of a giant ovarian tumour","volume":"6","author":"Madhu","year":"2013","journal-title":"Gynecol. Oncol. Case Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/1752-1947-8-32","article-title":"Anesthetic management in a patient with giant growing teratoma syndrome: A case report","volume":"8","author":"Ohashi","year":"2014","journal-title":"J. Med. Case Rep."},{"key":"ref_22","first-page":"170","article-title":"Anaesthetic implications and management of a giant ovarian cyst","volume":"8","author":"Kb","year":"2014","journal-title":"J. Clin. Diagn. Res. JCDR."},{"key":"ref_23","first-page":"1443","article-title":"Giant ovarian mucinous cystadenoma with borderline areas: A case report","volume":"55","author":"Sajin","year":"2014","journal-title":"Rom. J. Morphol. Embryol."},{"key":"ref_24","first-page":"19530","article-title":"Anesthetic management of a patient with giant retroperitoneal liposarcoma: Case report with literature review","volume":"8","author":"Feng","year":"2015","journal-title":"Int. J. Clin. Exp. Med."},{"key":"ref_25","unstructured":"(2015). Resection of a giant ovarian tumor the management challenge. MOJ Surg., 2, 00022. Available online: https:\/\/medcraveonline.com\/MOJS\/MOJS-02-00022.pdf."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1089\/gyn.2018.0008","article-title":"Management of a Giant Ovarian Tumor More Than 30 kg: A Case Report and Review of the Literature","volume":"34","author":"Akazawa","year":"2018","journal-title":"J. Gynecol. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e22625","DOI":"10.1097\/MD.0000000000022625","article-title":"Perioperative management of a patient with a giant ovarian tumor: A case report","volume":"99","author":"Cai","year":"2020","journal-title":"Medicine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"921887","DOI":"10.3389\/fsurg.2022.921887","article-title":"Anesthesia management of an aged patient with giant abdominal tumor and large hiatal hernia: A case report and literature review","volume":"9","author":"Xiang","year":"2022","journal-title":"Front. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"28","DOI":"10.2298\/AOO210617001B","article-title":"A patient with large retroperitoneal liposarcom\u2014A challenge for an anesthesiologist","volume":"28","author":"Bojanic","year":"2022","journal-title":"Arch. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1186\/s13256-022-03383-x","article-title":"Anesthetic management of a severely obese patient (body mass index 70.1 kg\/m2) undergoing giant ovarian tumor resection: A case report","volume":"16","author":"Yamochi","year":"2022","journal-title":"J. Med. Case Rep."},{"key":"ref_31","first-page":"273","article-title":"Multicystic ovarian tumor weighing 328 lb","volume":"1906","author":"Spohn","year":"1905","journal-title":"Tex. Med. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1016\/S0002-9378(16)38503-9","article-title":"Removal of 184 pound ovarian tumor, and observations regarding splanchnic shock","volume":"67","author":"Eames","year":"1954","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1006\/gyno.1994.1225","article-title":"Resection of a 303.2-pound ovarian tumor","volume":"54","year":"1994","journal-title":"Gynecol. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1097\/01.AOG.0000128106.96563.8b","article-title":"Abdominal compartment syndrome secondary to ovarian mucinous cystadenoma","volume":"104","author":"Chao","year":"2004","journal-title":"Obstet. Gynecol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1007\/s00134-006-0349-5","article-title":"Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome","volume":"32","author":"Malbrain","year":"2006","journal-title":"I. Definitions. Intensive Care Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1024\/0301-1526.37.3.278","article-title":"Acute iliofemoral deep venous thrombosis due to giant ovarian tumor: Report of a hybrid treatment","volume":"37","author":"Asciutto","year":"2008","journal-title":"VASA Z. Gefasskrankh."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1111\/anae.14299","article-title":"Videolaryngoscopy vs. fibreoptic bronchoscopy for awake tracheal intubation: A systematic review and meta-analysis","volume":"73","author":"Alhomary","year":"2018","journal-title":"Anaesthesia"},{"key":"ref_38","first-page":"971","article-title":"Awake Fiberoptic Intubation Protocols in the Operating Room for Anticipated Difficult Airway: A Systematic Review and Meta-analysis of Randomized Controlled Trials","volume":"128","author":"Cabrini","year":"2019","journal-title":"Obstet. Anesthesia Dig."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1097\/EJA.0000000000001194","article-title":"Rapid sequence induction: An international survey","volume":"37","author":"Klucka","year":"2020","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.thorsurg.2019.07.007","article-title":"Anesthetic Management for Paraesophageal Hernia Repair","volume":"29","author":"Kazakova","year":"2019","journal-title":"Thorac. Surg. Clin."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Rauch, S., Miller, C., Br\u00e4uer, A., Wallner, B., Bock, M., and Paal, P. (2021). Perioperative Hypothermia\u2014A Narrative Review. Int. J. Environ. Res. Public. Health, 18.","DOI":"10.3390\/ijerph18168749"},{"key":"ref_42","first-page":"625","article-title":"Morbidly obese patient with a huge ovarian tumor who was intubated while awake using airway scope in lateral decubitus position","volume":"59","author":"Shinohara","year":"2010","journal-title":"Masui. Jpn. J. Anesthesiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"376","DOI":"10.21037\/atm.2018.06.06","article-title":"The basics of respiratory mechanics: Ventilator-derived parameters","volume":"6","author":"Silva","year":"2018","journal-title":"Ann. Transl. Med."},{"key":"ref_44","first-page":"552","article-title":"Anesthetic management of a patient with a huge ovarian tumor","volume":"49","author":"Miyawaki","year":"2000","journal-title":"Masui. Jpn. J. Anesthesiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1097\/01.aoa.0000912212.90655.26","article-title":"Supine hypotensive syndrome of pregnancy: A review of current knowledge","volume":"43","author":"Massoth","year":"2023","journal-title":"Obstet. Anesthesia Dig."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e232139","DOI":"10.1136\/bcr-2019-232139","article-title":"Haemodynamic and respiratory changes following surgical resection of a giant ovarian cystadenoma","volume":"12","author":"Weinberg","year":"2019","journal-title":"BMJ Case Rep."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/S0003-4975(10)62480-0","article-title":"Reexpansion pulmonary edema","volume":"45","author":"Mahfood","year":"1988","journal-title":"Ann. Thorac. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1155\/2010\/259195","article-title":"Unilateral re-expansion pulmonary edema following treatment of pneumothorax with exceptionally massive sputum production, followed by circulatory collapse","volume":"17","author":"Komatsu","year":"2010","journal-title":"Can. Respir. J."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1920","DOI":"10.1378\/chest.102.6.1920b","article-title":"Reexpansion pulmonary edema","volume":"102","author":"Davies","year":"1992","journal-title":"Chest"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2314","DOI":"10.1007\/s00134-020-06288-9","article-title":"Clinical strategies for implementing lung and diaphragm-protective ventilation: Avoiding insufficient and excessive effort","volume":"46","author":"Goligher","year":"2020","journal-title":"Intensiv. Care Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1007\/s11894-017-0566-9","article-title":"A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction","volume":"19","author":"Cappell","year":"2017","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_52","first-page":"473","article-title":"Large ovarian tumor. Report of a case","volume":"22","author":"Symmonds","year":"1963","journal-title":"Obstet Gynecol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1093\/bja\/39.8.612","article-title":"Effect of thoracic and abdominal pressure changes on the epidural space pressure","volume":"39","author":"Usubiaga","year":"1967","journal-title":"Br. J. Anaesth."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1053\/j.jvca.2014.02.020","article-title":"The Vigileo-FloTracTM system: Arterial waveform analysis for measuring cardiac output and predicting fluid responsiveness: A clinical review","volume":"28","author":"Suehiro","year":"2014","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1586\/17434440.2013.844464","article-title":"FloTrac\/Vigileo system monitoring in acute-care surgery: Current and future trends","volume":"10","author":"Tsai","year":"2013","journal-title":"Expert Rev. Med. Devices"},{"key":"ref_56","first-page":"e16315","article-title":"Airway Anesthesia for Awake Tracheal Intubation: A Review of the Literature","volume":"13","author":"Kostyk","year":"2021","journal-title":"Cureus"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/5\/1321\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:05:06Z","timestamp":1760105106000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/5\/1321"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,26]]},"references-count":56,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["jcm13051321"],"URL":"https:\/\/doi.org\/10.3390\/jcm13051321","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,26]]}}}