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Patients with an anterior mediastinal mass pose significant risk for cardiorespiratory compromise during surgical procedures and general anesthesia. Several techniques have been described to reverse airway obstruction in these patients. In extreme circumstances, patients may require cardiac bypass or extracorporeal membrane oxygenation (ECMO) until...
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Context 1
... made. A bone hook was wedged into the sternum and the sternum was elevated manually, which allowed for immediate return of ventilation. With this temporizing measure, the chest was quickly prepped and draped, and the RulTract Ò retractor system with a bone-hook clamp inserted into the sternum was utilized for sus- tained elevation of the sternum (Fig. ...
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Objective:
To review the principles of neonatal-pediatric extracorporeal membrane oxygenation (ECMO) therapy, prognosis, and its establishment in limited resource-limited countries in Latino America.
Sources:
The PubMed database was explored from 1985 up to the present, selecting from highly-indexed and leading Latin American journals, and Extra...
Despite a potentially effective therapy for adult respiratory failure, a general agreement on venovenous extracorporeal membrane oxygenation (VV-ECMO) has not been reached among institutions due to its invasiveness and high resource usage. To establish consensus on the timing of intervention, large ECMO organizations have published the respiratory...
Background
Indications for using veno‐arterial extracorporeal membrane oxygenation (V‐A ECMO) in sepsis cases remain unclear.
Case Presentation
A 66‐year‐old man with pre‐existing chronic heart failure developed severe pneumonia resulting in refractory septic shock. He was diagnosed with septic cardiomyopathy based on depressed left ventricular ej...
Citations
... The plan was to emergently start the forced sternal elevation procedure if the anterior mediastinal compression caused sudden cardiovascular collapse. This technique was previously utilized and published for restoration of ventilation after catastrophic anterior mediastinal compression related to tumor undergoing biopsy [6]. ...
While pectus excavatum is the most common congenital chest wall deformity in children, indications for surgical repair are still debated among experts. Some centers require demonstration of physiologic criteria prior to repair, even in the face of significant anatomic compression. We present a case of a 16-year-old male with severe pectus excavatum who presented with a 3-year history of a chronic barking cough and exercise-induced shortness of breath. Radiographic imaging demonstrated compression of the trachea and bilateral mainstem bronchi secondary to severe pectus excavatum deformity. Despite his severe pectus deformity, preoperative physiologic testing demonstrated normal to near-normal cardiopulmonary function. Minimally invasive repair of the chest wall defect (modified Nuss procedure) provided rapid alleviation of symptoms, and a significant improvement in quality of life.
Objectives
To summarize the anesthetic management of patients undergoing mediastinal mass operation.Methods
Electronic databases were searched to identify all case reports of patients undergoing mediastinal mass operation. Information such as clinical characteristics, perioperative management and patients’ outcomes were abstracted and analyzed.ResultsSeventy-seven case reports with 85 patients aging from 34 days to 81 years were included. Mediastinal masses were located in anterior (n = 48), superior (n = 15), middle (n = 9) and posterior (n = 9) mediastinum, respectively. Clinical manifestations included dyspnea (n = 45), cough (n = 29), chest or radiating pain (n = 12), swelling (n = 8), fever (n = 7) and chest distress (n = 4). Most patients (n = 75) had signs of compression or invasion of vital structures. General anesthesia (n = 76) was the most commonly used method of anesthesia. Muscle relaxants were administered in 35 patients during anesthesia induction and spontaneous respiration was maintained in 37 patients. Mediastinal mass syndrome (MMS) occurred in 39 cases. Extracorporeal circulation was utilized in 20 patients intraoperatively. Three patients experienced cardiac arrest after ventilation failure and two patients died intraoperatively and one postoperatively.Conclusions
Peri-operative management of patients undergoing mediastinal mass operation could be challenging. Pre-operative multi-disciplinary discussion, well-planned anesthetic management and pre-determined protocols for emergency situations are all vital to patient safety.
An anterior mediastinal mass is one of the most challenging pathologies an anesthesiologist may face during his or her career. To safely care for these patients, it is imperative to know the relevant anatomy of the mediastinum, understand how mediastinal pathology can compromise a patient’s respiratory and cardiovascular systems, and recognize how to prepare for and quickly treat these potentially life-threatening complications. In this chapter, we will present a case of an anterior mediastinal mass with superior vena cava syndrome. We will discuss the important preoperative testing, preanesthetic considerations, risk stratification, and intraoperative anesthetic management. We will also present a flowchart with potential management strategies to assist in safely caring for the majority of these patients.
