Anesthetic management for abdominoperineal resection of the rectum in a patient with superior vena cava syndrome

: Since superior vena cava syndrome (SVCs) causes ntracranial hypertension and edema of the upper respiratory tract close attention should be paid to brain circulatory dysfunction and obstruction of the upper airway. A male patient with SVCs and complete obstruction of the bilateral internal jugular veins was scheduled for abdominoperineal resection of the rectum under general anesthesia To evaluate the brain circuation, we monitored the external jugular venous pressure and regional saturation of oxygen (rSO) by INVOS® in the cerebral frontal cortex. If the external ugular venous pressure would rise above 20 mmHg, we planned to change the horizontal supine position to a head up position and then remove blood from the external jugular vein. Fortunately, since the external jugular venous pressure was maintained within 20 mmHg, and since no great decreases in rSO2 occurred during surgery, we did not change the patient's position or remove blood from the patient. The surgical procedure was completed uneventfully, and pharyngoarngeal edema was not seen. He did not show any neurological deficits after surgery. From experience of khis patient, we concluded that monitoring of external cigular venous pressure and rSO2 is useful for anesthetic management in patints with SVCs.