Anesthetic Management of a Patient With Central Airway Compression Due to Posterior Mediastinal Mass

Sulen, Nina; Petani, Barbara; Bačić, Ivan; Morović, Domagoj

doi:10.20471/acc.2016.55.s1.16

Cited by 3 publications

(1 citation statement)

References 11 publications

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“…The literature review revealed a few case reports that have described different approaches to managing BCs located in various mediastinal regions. For instance, Sulen et al [17] employed awake fiberoptic intubation with an endobronchial tube for a cyst in the posterior mediastinum, while Wools et al [18] conducted an emergency tracheostomy for cysts in the superior mediastinum, which presented with a stridor and was later managed with a thoracotomy. Furugen et al [19] addressed a recurrent BC tightly attached to the left atrium through sternotomy and CPB.…”

Section: Figure 6: Postoperative Chest X-ray Pa View Discussionmentioning

confidence: 99%

Anesthetic Management of Large Bronchogenic Cyst With Severe Tracheal Compression in Adults: A Case Report

Sandeep,

Kalbande,

Gupta

et al. 2024

Cureus

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Bronchogenic cysts (BCs) are a congenital anomaly, forming fluid-filled sacs in the bronchial tree during fetal development, and are relatively rare in adults. Patients with large BCs in the mediastinum presenting with severe tracheal compression pose a significant challenge to anesthesiologists. The confined and narrow space of the mediastinum exacerbates the compression effect on surrounding structures, leading to potential respiratory or cardiovascular collapse during anesthesia and postoperatively. Herein, we report the stepwise anesthetic management of a patient with a BC in the paratracheal region of superior mediastinum, causing near-complete tracheal compression, scheduled for right posterolateral thoracotomy and tumor excision. The patient presented with dyspnea, chest pain, cough, and severe tracheal compression necessitating meticulous airway management. Utilizing awake fiberoptic intubation with a single-lumen endotracheal tube and one-lung ventilation facilitated by an EZ bronchial blocker, we successfully secured the airway, provided ideal surgical conditions through lung deflation, and ensured perioperative safety. This case underscores the crucial role of comprehending the underlying pathophysiology, anticipating complications, and meticulously planning, preparing, and executing strategies for airway management and perioperative care in patients with mediastinal masses leading to significant tracheal compression.

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Section: Figure 6: Postoperative Chest X-ray Pa View Discussionmentioning

confidence: 99%

Anesthetic Management of Large Bronchogenic Cyst With Severe Tracheal Compression in Adults: A Case Report

Sandeep,

Kalbande,

Gupta

et al. 2024

Cureus

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Perioperative Management of a Patient with Large Anterior Mediastinal Mass and Cardiopulmonary Compromise: An Updated Algorithm

Flaten¹,

M²,

Walker³

2020

kjm

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INTRODUCTION Patients who present with an anterior mediastinal mass (AMM) pose complex risks for the anesthesiologist to consider. While AMMs are quite rare, especially in the adult patient population, they are related most commonly to lymphoma, thymoma, germ cell tumor, granuloma, bronchogenic carcinoma, thyroid tumors, bronchogenic cyst, and cystic hygromas, in order of frequency. 1,2 Since the 1970s, intraoperative complication rates of 7-20% have been reported, ranging from mild hypoxia and hypotension to complete cardiovascular collapse, airway compression, and death. 3,4 When the best practices for anesthetic management of AMM's are adhered to, including maintenance of spontaneous ventilation and avoidance of supine positioning, mortality remains relatively low, ranging from 0.3-1.1%. 5 However, some of these complications may be unavoidable despite adhering to standard practices for perioperative AMM management and require appropriate preparation and time-critical intervention to avoid serious injury or death. 4 We present a brief overview of the important principles and practices concerning the management of AMM and suggest an updated algorithm with emphasis on preoperative risk stratification. Furthermore, we describe a unique case of significant hypoxemia with normotension in the setting of severe contralateral tracheobronchial and pulmonary artery compression to illustrate these points.

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Anesthetic management of patients undergoing mediastinal mass operation

Tan

Lin²,

He³

et al. 2022

Front. Surg.

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ObjectivesTo summarize the anesthetic management of patients undergoing mediastinal mass operation.MethodsElectronic 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.ConclusionsPeri-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.

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Anesthetic Management of a Patient With Central Airway Compression Due to Posterior Mediastinal Mass

Cited by 3 publications

References 11 publications

Anesthetic Management of Large Bronchogenic Cyst With Severe Tracheal Compression in Adults: A Case Report

Anesthetic Management of Large Bronchogenic Cyst With Severe Tracheal Compression in Adults: A Case Report

Perioperative Management of a Patient with Large Anterior Mediastinal Mass and Cardiopulmonary Compromise: An Updated Algorithm

Anesthetic management of patients undergoing mediastinal mass operation

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