ECMO and adult mediastinal masses

Ramanathan, Kollengode; Leow, Lowell; Mithiran, Harish

doi:10.1007/s12055-020-01077-x

Cited by 14 publications

(13 citation statements)

References 30 publications

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“…Furthermore, increased intrathoracic pressure due to positive pressure ventilation after intubation may worsen airway obstruction, resulting in further respiratory failure and circulatory collapse [2,3]. In such cases, extracorporeal membrane oxygenation (ECMO) should be provided in conjunction with general anesthesia [4,5]. In our case, CT-guided drainage of the fluid contents of the tumor was effective in decompressing the airway obstruction and allowed safe general anesthesia induction and surgical resection without ECLS.…”

Section: Discussionmentioning

confidence: 79%

Rescue computed tomography-guided drainage of a giant mediastinal mature teratoma causing airway obstruction prior to surgical resection: a case report

et al. 2023

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Background Giant mediastinal mature teratomas may cause airway obstruction or decreased venous return due to the mass effect. Preoperative stabilization of the respiratory and circulatory systems is important for perioperative management to safely perform surgery, including general anesthesia. However, to the best of our knowledge, there are only a few reports regarding the preoperative computed tomography (CT)-guided drainage of mediastinal tumors. Case presentation A 30-year-old woman was admitted to the emergency room with sudden dyspnea. CT findings revealed a giant cystic mass in the anterior mediastinum compressing the trachea and the right main bronchus. The patient was intubated and CT-guided drainage of the fluid content of the cyst was performed to decompress the airway obstruction. Thereafter, the mediastinal tumor was resected during elective surgery and pathologically diagnosed as a mature teratoma. Conclusions Rescue preoperative CT-guided drainage of a giant mediastinal mature teratoma allowed safe general anesthesia and surgery by releasing the airway obstruction.

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Section: Discussionmentioning

confidence: 79%

Rescue computed tomography-guided drainage of a giant mediastinal mature teratoma causing airway obstruction prior to surgical resection: a case report

et al. 2023

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“…Tracheal or bronchial tumours with fixed airway obstruction may be managed on VV ECMO [9]. If in doubt, we recommend insertion of VA ECMO first with a view for an additional venous cannula if required [16]. As seen in case 1, we attempted VV initially but were unable to sustain oxygenation with just venous cannulas.…”

Section: Discussionmentioning

confidence: 99%

“…In a patient with good cardiac output, this can lead to differential hypoxia, however, it might afford sufficient time for a definitive airway or a tracheostomy to be performed. We encourage open multidisciplinary discussions prior to embarking on such endeavours and to establish clear thresholds not only for instituting but also withdrawing ECMO support [16]. Differential hypoxia should be routinely looked for in all patients with VA ECMO especially if cardiac function remains preserved.…”

Section: Discussionmentioning

confidence: 99%

Rescue extracorporeal membrane oxygenation for massive anterior mediastinal masses

et al. 2021

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The management of massive anterior mediastinal masses (AMM) is challenging. With the burgeoning role of extracorporeal membrane oxygenation support (ECMO) beyond the confines of salvage therapy, more trained clinicians are adopting it as a bridge for high-risk procedures or situations where temporary respiratory or cardiac support is required. We report our experience with using ECMO in the management of massive AMM in this case series of three patients sharing their clinical details and the lessons learned from them.

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“…Traditional anesthetic approaches include inhalation induction and awake intubation. Previous recommendations have advised against the use of muscle relaxant and recommend maintenance of spontaneous ventilation [2]. Back up plans have included change in patient position, rigid bronchoscopy, ECMO or waking patient up from general anesthesia [3].…”

Section: Central Airway Obstructionmentioning

confidence: 99%

Anesthetic considerations in interventional pulmonology

Sikachi,

Mishra,

Anders

2023

Current Opinion in Pulmonary Medicine

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Purpose of review In this review, we highlight the important anesthetic consideration that relate to interventional bronchoscopic procedures for the management of central airway obstruction due to anterior mediastinal masses, endoluminal endobronchial obstruction, peripheral bronchoscopy for diagnosis and treatment of lung nodules, bronchoscopic lung volume reduction and medical pleuroscopy for diagnosis and management of pleural diseases. Recent findings The advent of the field of Interventional Pulmonology has allowed for minimally invasive options for patients with a wide range of lung diseases which at times have replaced more invasive surgical procedures. Ongoing research has shed light on advancement in anesthetic techniques and management strategies that have increased the safety during peri-operative management during these complex procedures. Current evidence focusing on the anesthetic techniques is presented here. Summary The field of Interventional Pulmonology requires a tailored anesthetic approach. Recent advancements and ongoing research have focused on expanding the partnership between the anesthesiologist and interventional pulmonologists which has led to improved outcomes for patients undergoing these procedures.

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ECMO and adult mediastinal masses

Cited by 14 publications

References 30 publications

Rescue computed tomography-guided drainage of a giant mediastinal mature teratoma causing airway obstruction prior to surgical resection: a case report

Rescue computed tomography-guided drainage of a giant mediastinal mature teratoma causing airway obstruction prior to surgical resection: a case report

Rescue extracorporeal membrane oxygenation for massive anterior mediastinal masses

Anesthetic considerations in interventional pulmonology

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