A case of successful anesthetic management in a patient with Trousseau's syndrome who underwent surgery for malignant ovarian tumor.

Background: Trousseau's syndrome, also known as cancer-associated thrombosis, has several perioperative considerations, including the timing of surgery, anticoagulant therapy, and anesthetic technique. While appropriate anesthetic management is critical, few clinical reports have addressed the issue. Here, we report a patient with Trousseau's syndrome who successfully underwent gynecological surgery 1 month after a massive cerebral infarction.

Case Presentation: A 46-year-old woman with malignant ovarian tumor and deep venous thrombosis developed systemic thromboembolism, including a massive right cerebral infarction, despite receiving direct oral anticoagulant therapy. She was diagnosed with Trousseau's syndrome and was transferred to our hospital 17 days after the onset of cerebral infarction with left incomplete hemiparesis. Semi-radical gynecological surgery was scheduled in another 14 days (31 days after the cerebral infarction). A temporary inferior vena cava filter was placed, and both direct oral anticoagulant and antiplatelet drugs were substituted with unfractionated heparin infusion. She underwent surgery uneventfully under general anesthesia with desflurane and remifentanil. Postoperative analgesia was achieved with a peripheral nerve block and continuous intravenous infusion of fentanyl. The tumors were fully resected, thereby only anticoagulant therapy for residual venous thrombus was continued. She had a good perioperative course and was discharged without cerebral complications or thromboembolism.

Conclusions: In patients with Trousseau's syndrome, both early radical surgery and preventing perioperative cerebrovascular complications are critical. In our present case, Trousseau's syndrome was successfully operated under general anesthesia 1 month after a massive cerebral infarction.