Current anesthesiological approach to mediastinal surgery

Gálvez, Carlos; Galiana, María; Corcoles, Juan Manuel; Lirio, Francisco; Sesma, Julio; Bolufer, Sergio

doi:10.21037/jovs.2018.05.26

Cited by 3 publications

(2 citation statements)

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“…e presence of respiratory symptoms such as dyspnea, orthopnea, postural dyspnea, or stridor must alert for central airway compression and increased risk of perioperative complications [6]. Patients can be categorized into three categories according to risk: (i) Low risk (ii) Middle risk (iii) High risk ose considered to be high risk may present with severe postural symptoms, stridor, cyanosis, and radiological evidence of more than 50% airway obstruction, tracheal compression with bronchial compression, pericardial effusion, or superior vena cava syndrome [6]. Relaxation of bronchial smooth muscles under anesthesia increases the risk of airway obstruction since they are already made narrow by the external pressure of the mass [7].…”

Section: Discussionmentioning

confidence: 99%

Procedural Sedation with Dexmedetomidine for Anterior Mediastinotomy in a High-Risk Patient

Pratas

Aires

Silva

et al. 2022

Case Reports in Anesthesiology

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Perioperative management of patients with mediastinal masses still poses a challenge for the anesthesiologist, as the use of general anesthesia can be associated with acute perioperative cardiorespiratory impairment resulting from the mass collapsing on the airway or vascular structures. Dexmedetomidine can be used for procedural sedation due to its reversible sedative and anxiolytic properties with dose-dependent effects, while not interfering with ventilatory drive. These features are of particular interest for the perioperative management of patients with large anterior mediastinal masses. In this case, we report our anesthetic management of a 22-year-old male scheduled for anterior mediastinotomy, with a large anterior mediastinal mass, with 50% distal tracheal compression and marked collapse of the superior vena cava and brachiocephalic trunk. In the operation theatre, an infusion of dexmedetomidine was titrated to adequate anesthetic depth while keeping the patient under spontaneous ventilation with oxygen (O2) supplementation and local anesthetic infiltration of the surgical site. Mediastinotomy lasted for about 30 minutes, during which the patient maintained appropriate ventilation and hemodynamic stability. No adverse events occurred perioperatively. Diagnostic procedures such as mediastinotomy for tissue biopsy are necessary to achieve a histological diagnosis. High-risk patients may present with severe postural symptoms, stridor, cyanosis, and radiological evidence of more than 50% airway obstruction, tracheal compression with bronchial compression, pericardial effusion, or superior vena cava syndrome. Relaxation of bronchial smooth muscles under general anesthesia increases the risk of airway obstruction. In this case, with the use of dexmedetomidine combined with local anesthetic infiltration, spontaneous ventilation and muscle tone were preserved, decreasing the probability of intraoperative complications. It is our opinion that dexmedetomidine combined with local anesthetic infiltration can be a safe option for procedural sedation in patients presenting with high-risk anterior mediastinal masses for mediastinotomy.

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Section: Discussionmentioning

confidence: 99%

Procedural Sedation with Dexmedetomidine for Anterior Mediastinotomy in a High-Risk Patient

Pratas

Aires

Silva

et al. 2022

Case Reports in Anesthesiology

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“…Anesthesiologic management of mediastinal surgery is complex, due to neoplastic compression of vessels or airway [ 40 , 41 , 42 ]. Avoiding general anesthesia and orotracheal intubation, the morbidity rate was low in our study population, with only a few cases of adverse events that were easily managed with a conservative approach or minimally invasive drainage.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Anterior Mediastinotomy: A Feasible Tool for Critical Lymphoma Patients

et al. 2021

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A significant part of all neoplasms growing in anterior mediastinum are lymphomas (25%). Achieving a correct diagnosis and a clear definition of a lymphoma’s subtype is crucial for beginning chemotherapy as soon as possible. However, most patients present a large mediastinal mass that compresses vessels and airway, with serious cardiorespiratory repercussions. Therefore, having multiple tools available to biopsy the lesion without worsening morbidity becomes fundamental. Patients enrolled in this study were unfit for a surgical biopsy in general anesthesia and the need to begin chemotherapy as fast as possible prompted us to avoid percutaneous fine needle aspiration to prevent diagnostic failures. Our observational study included 13 consecutive patients with radiological findings of anterior mediastinal mass. Ultrasonography was performed directly in the theatre to mark the lesion and to localize vessels and vascularized neoplastic tissue. Open biopsy was carried out in spontaneous breathing with a laryngeal mask and with short-acting medications for a rapid anesthesia, performing an anterior mediastinotomy. The mean operative time was 33.4 ± 6.2 min and spontaneous respiration was maintained throughout the procedure. No complications were reported. All patients were discharged in the first or second postoperative day after a chest X-ray (1.38 ± 0.5 days). The diagnostic yield of this approach was 100%. With the addition of ultrasonography right before the procedure and with spontaneous breathing, anterior mediastinotomy still represents a useful tool in critical patients that could hardly tolerate a general anesthesia. The diagnostic yield is high, and the low postoperative morbidity allows a rapid onset of chemotherapy.

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Cardiovascular and airway consideration in pediatric thoracic anterior mediastinal mass

Dammalapati

2024

Indian J Thorac Cardiovasc Surg

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Current anesthesiological approach to mediastinal surgery

Cited by 3 publications

References 0 publications

Procedural Sedation with Dexmedetomidine for Anterior Mediastinotomy in a High-Risk Patient

Procedural Sedation with Dexmedetomidine for Anterior Mediastinotomy in a High-Risk Patient

Ultrasound-Guided Anterior Mediastinotomy: A Feasible Tool for Critical Lymphoma Patients

Cardiovascular and airway consideration in pediatric thoracic anterior mediastinal mass

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