Despite the considerable risk of lactic acidosis in the majority of patients, no cases were observed.

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Patient: Female, 76 Final Diagnosis: Right upper lung tumor with severe pulmonary hypertension Symptoms: Shortness of breath Medication: — Clinical Procedure: Ecective bronxhoscopy • robotic right upper lobectomy • thoracic lymphadenectomy Specialty: Anesthesiology Objective: Rare co-existance of disease or pathology Background: It is very challenging for anesthesiologists to manage patients with pulmonary hypertension undergoing general anesthesia for elective or emergent surgeries. Case Report: We present a patient with severe pulmonary hypertension going through a major robotic thoracic surgery. Conclusions: A goal-directed anesthesia management algorithm based on serial stroke volume (SV) values obtained from FloTrac (Edwards Lifesciences, LLC.) minimally invasive arterial pressure sensor was utilized in an attempt to reduce the anesthetic and surgical risk associated with severe pulmonary hypertension.

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