ANESTHETIC MANAGEMENT OF A PATIENT WITH PULMONARY ASPERGILLOMA UNDERGOING THORACOTOMY AND LOBECTOMY: A CASE REPORT

Abstract

Aspergillosis is most commonly caused by the fungus Aspergillus fumigatus. Aspergilloma (fungal ball), develops in post-tuberculous cavities. In many cases, the only therapeutic option is resection of the lung parenchyma colonized by the fungus. Despite this, postoperative care is associated with a relatively high risk of complications. We report a 35-year-old male patient with pulmonary aspergilloma. A right upper lobectomy was performed through thoracotomy using one-lung ventilation (OLV) with a double-lumen endotracheal tube (ETT) placed on the left side. Invasive monitoring included central venous catheter (CVC), arterial line, and EtCO2 monitoring. Postoperatively, pain management and fast-track extubation were implemented. Aspergillus fumigatus spores are widespread in the environment, and hyphae are relatively frequently found in sputum samples. In many cases, diagnosis is based on radiological examination. Management of aspergilloma is complex and still controversial; surgical recommendations are only for patients in good general condition without significant comorbidities. General anesthesia with OLV is crucial for optimal lung visualization but may lead to pulmonary complications, particularly postoperatively. During ICU care, effective pain management is essential for patient comfort and timely extubation. Pneumonectomy should only be considered as a last resort due to its high mortality rate. Proper preoperative assessment, risk stratification, and postoperative counseling are critical. A multidisciplinary approach helps optimize patient care in the postoperative period, allowing for early detection and treatment of potentially fatal complications.