Patient repositioning and the amelioration of airway obstruction by an anterior mediastinal tumor during general anesthesia -A case report-

Abstract

An 18-year-old male with huge anterior mediastinum mass was scheduled for thoracotomic incisional biopsy under general anesthesia after failed fluoroscopy-guided percutaneous needle biopsy. Under propofol and succinylcholine anesthesia, intubation was successfully achieved using a Univent tube. However, when we changed the patient's position from supine to right lateral decubitus, oxygen saturation declined. He was then positioned supine, but hypoxemia did not improve. Because the tumor expanded toward the left thoracic field, we considered that the left lateral decubitus position might help relieve the mass effect on the main bronchus. His position was changed accordingly and soon after, hypoxemia improved and surgery was undertaken under cardiopulmonary bypass (CPB). The biopsy was successfully performed under CPB without complication.

La prise en charge de l’anesthésie des patients avec une masse médiastinale antérieure

“…38,39 Idéalement, la position de « sauvetage » correcte devrait être déterminée en période préopératoire et choisie en fonction de la relation anatomique entre la masse et la structure comprimée et l'amélioration des symptômes dans certaines positions spécifiques. Parmi les positions de « sauvetage » possibles, citons la position assise à la verticale, le décubitus latéral, 38,39 ou la position ventrale, selon la relation anatomique entre la masse et les voies aériennes. Le recours à un bronchoscope rigide et à un médecin compétent en la matière peut être nécessaire en cas de perte des voies aériennes.…”

“…38,39 Ideally, the correct ''rescue'' position should be determined preoperatively and chosen on the basis of the anatomic relationship between the mass and the compressed structure and improvement in symptoms in specific positions. ''Rescue'' positions may include upright seated, lateral decubitus, 38,39 or prone positions depending on the anatomic relationship between the mass and the airway. Recourse to rigid bronchoscopy and a physician skilled in its use may be necessary in the event of airway loss.…”

Anesthesia for massive retrosternal goiter with severe intrathoracic tracheal narrowing: the challenges imposed -A case report-

“…It can occur at every stage of anesthesia up to the postoperative period [6] or even simply by a change of posture [7]. Acute respiratory and/or cardiovascular decompensation can occur.…”

Perioperative Management of the Pregnant Patient with an Anterior Mediastinal Mass

“…A rescue plan was predetermined in case the patient became unstable, and included placing the patient in the right lateral decubitus position. 35 This position was chosen based on the known right-sided tumor location; anticipating gravity would relieve any worsening obstruction. It should also be noted that at all times rigid bronchoscopy was immediately available with the surgeon at the bedside.…”