Anterior mediastinal masses in children

McLeod, Michael K.; Dobbie, M

doi:10.1016/j.bjae.2018.10.001

Cited by 13 publications

(36 citation statements)

References 13 publications

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“…Local anesthesia, with anxiolysis or light sedation, is administered for minor procedures in cooperative patients. Algorithms concerning the management of pediatric patients with a mediastinal mass have been published 5,8,12,22 . During the preoperative mediastinal mass huddle, the need for the availability of a provider proficient with ventilation via rigid bronchoscopy is discussed.…”

Section: Discussionmentioning

confidence: 99%

“…Algorithms concerning the management of pediatric patients with a mediastinal mass have been published. 5,8,12,22 During the preoperative mediastinal mass huddle, the need for the availability of a provider proficient with ventilation via rigid bron- The anesthetic management of patients with a mediastinal mass is individualized. If resection of the mass is not needed, it is typical at our institution that the procedures be performed via the administration of dexmedetomidine and ketamine, using a natural airway.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for anesthetic‐related complications in pediatric patients with a newly diagnosed mediastinal mass

Campbell

Tsai

Reading

et al. 2021

Pediatric Anesthesia

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Background: Pediatric patients with a mediastinal mass can experience severe complications while undergoing anesthesia. Nearly, all published reviews involve either patients with an anterior mediastinal mass or patients with an oncologic disease. Aim:The identification of risk factors for anesthetic-related complications in pediatric patients with any type of mediastinal mass. Methods:From January 1, 2008 to December 31, 2019, patients with a newly diagnosed mediastinal mass that underwent anesthesia were retrospectively identified. Each patient's medical record was reviewed for presenting symptoms, preprocedure imaging results, the type of anesthetic delivered, and the occurrence of any anesthetic-related complications. A complication was defined as severe hypoxia, severe hypotension, or loss of endtidal carbon dioxide.Results: Eighty-six patients presented with a new mediastinal mass. Six of these patients (7%) had a complication. Complications were no more likely in patients with orthopnea than in patients without orthopnea (P = 1.00; relative risk (RR) = 0.95; 95% CI (0.1, 7.5). Complication rates in patients with anterior, middle, and posterior mediastinal masses were similar, as were complication rates in patients with large, medium, and small masses. Six of the 41 patients (15%) who had tracheal compression had a complication, while none of the 45 patients (0%) who did not have tracheal compression had a complication (p = .0096). Six of the 48 patients (13%) that were intubated had a complication, while none of the 38 patients (0%) who were not intubated had a complication (p = .032). Five of 36 patients (14%) who had mainstem bronchus compression had a complication, while one of 50 patients (2%) who did not have mainstem bronchus compression had a complication (p = .078; RR = 6.9l; 95% CI (0.8, 56.9)).Conclusions: Anesthetic-related complications were associated with airway compression and endotracheal intubation. The absence of preprocedure orthopnea did not ensure that the anesthetic would be uncomplicated. Complications occurred in similar frequencies in patients with a mediastinal mass of any location or size.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk factors for anesthetic‐related complications in pediatric patients with a newly diagnosed mediastinal mass

Campbell

Tsai

Reading

et al. 2021

Pediatric Anesthesia

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“…11 It is also important to determine the "rescue" position which alleviates symptoms and in which the patient feels the most comfortable. 14 This is the position that relieves the mass effect on critical mediastinal structures. 15,16…”

Section: Key Pointsmentioning

confidence: 99%

“…This includes procedures such as mediastinoscopy, video-assisted thoracoscopy, thoracotomy, sternotomy, or biopsy of deep tissue sites remote to the mediastinal mass. 14 All children must be thoroughly assessed clinically and the decision to proceed to general anesthesia should be made by a multidisciplinary team including senior anesthetists, surgeons, radiologists, and oncologists. a General anesthesia with endotracheal intubation was administered in 45 patients.…”

Section: Ane S the Ti C Manag Ementmentioning

confidence: 99%

Anesthesia for children with anterior mediastinal masses

Tan

Nolan

2021

Pediatric Anesthesia

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Children with an anterior mediastinal mass may have cardiopulmonary compromise that can be exacerbated under general anesthesia. Signs and symptoms such as cough, shortness of breath, stridor, orthopnea, accessory muscle use, a history of respiratory arrest, and the presence of a pleural effusion and upper body edema are predictive of perioperative complications. A larger mediastinal mass on imaging is predictive of perioperative complications. Risk stratification of patients, together with an individualized plan, will best guide operative management for patients with an anterior mediastinal mass. General anesthesia (GA) should be avoided if possible, but a spontaneous breathing technique is recommended if GA is required.

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“…High-risk symptoms for decompensation include cough, noisy breathing with stridor or wheeze, orthopnoea and syncope. 45 , 51 – 54 Clinical signs of cyanosis, upper body oedema, engorgement of veins and pulsus paradoxical changes in blood pressure might indicate significant mass effects on surrounding anatomical structures. 45 , 51 – 55 …”

Section: Reviewmentioning

confidence: 99%

Therapeutics for paediatric oncological emergencies

Leung¹,

Hon²,

Hui³

et al. 2021

DIC

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Background With advancements in the field of oncology, cancer survival rates have improved dramatically but modern cancer treatments also come with an increasing number of disease and treatment-associated complications. This article provides an updated narrative review on the pathophysiology, clinical presentations and latest management strategies for common paediatric oncological emergencies. Methods An extensive PubMed ® search of all human studies in the English literature was performed in Clinical Queries for different oncology syndromes and conditions using the following Medical Subject Headings: “tumour lysis syndrome”, “hyperleukocytosis”, “disseminated intravascular coagulation”, “superior mediastinal syndrome”, “superior vena cava syndrome”, “sepsis”, “severe inflammatory response syndrome”, “acute respiratory distress syndrome”, “posterior reversible encephalopathy syndrome” and “reversible posterior leukoencephalopathy syndrome”. Categories were limited to clinical trials and reviews for ages from birth to 18 years. Results The general description, presentation and management of these oncologic emergencies are systematically described. Early recognition along with prompt and proactive treatment can reduce the chances of potential complications and improve the clinical outcomes, thereby improving not only survival rates in oncology patients but also their clinical outcomes and quality of life. Conclusions Oncologic emergencies are associated with significant mortality and morbidity. Healthcare professionals involved with the care of oncology patients must be vigilant of these emergencies.

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Anterior mediastinal masses in children

Cited by 13 publications

References 13 publications

Risk factors for anesthetic‐related complications in pediatric patients with a newly diagnosed mediastinal mass

Risk factors for anesthetic‐related complications in pediatric patients with a newly diagnosed mediastinal mass

Anesthesia for children with anterior mediastinal masses

Therapeutics for paediatric oncological emergencies

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