Perioperative Management of the Pregnant Patient with an Anterior Mediastinal Mass

Kanellakos, George W.

doi:10.1016/j.anclin.2012.07.010

Cited by 9 publications

(10 citation statements)

References 36 publications

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“…We have included 136 reports, both full publications and abstracts, covering 158 cases (see also Supporting Information, Appendices S1–S6) . Case reports largely fall into two groups: those describing equipment, or a technique, for provision of general anaesthesia; or those identifying a woman who had predicted airway difficulty, who was managed with regional analgesia or anaesthesia with the aim of avoiding of general anaesthesia.…”

Section: Resultsmentioning

confidence: 99%

Anticipated difficult airway during obstetric general anaesthesia: narrative literature review and management recommendations.

2020

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We reviewed the literature on management of general and regional anaesthesia in pregnant women with anticipated airway difficulty. We identified 138 publications comprising 158 cases; these either described equipment or techniques for the provision of general anaesthesia, or the management of women with regional analgesia or anaesthesia, with the aim of avoiding general anaesthesia. Most of the former group described women requiring caesarean section alone, or in combination with other surgery, which was sometimes airwayrelated. Management techniques were largely similar to those in non-obstetric patients requiring surgery who have airway difficulties, although suggested differences related to physiological changes of pregnancy and avoidance of nasal intubation. In the reports discussing regional anaesthesia, consideration was often given to the possible requirement for urgent out-of-hours anaesthetic intervention, and the predicted difficulty of management of general anaesthesia should it be required. In a number of reported cases, multidisciplinary planning led to the conclusion that elective caesarean section should be performed in order to avoid emergency airway management. Based on this literature review, we advise antenatal planning that includes: assessment of the patient's clinical characteristics; consideration of the equipment and personnel available to provide safe airway management out-of-hours; and elective caesarean section should these be lacking. If general anaesthesia is required, a risk assessment must be made as to the probability of safe airway management after the induction of anaesthesia, and awake tracheal intubation should be used if this cannot be assured. Decision aids are provided to illustrate these points. Online appendices include a comprehensive compendium of case reports on the management of a number of rare syndromes and airway conditions.

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Section: Resultsmentioning

confidence: 99%

Anticipated difficult airway during obstetric general anaesthesia: narrative literature review and management recommendations.

2020

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“…The symptoms are due to compression of the mediastinal structures, namely the tracheobronchial tree, pulmonary arteries, aortic arch, SVC and cardiac chambers. [ 4 ] The initial diagnosis might be difficult due to the symptoms being attributed to the pregnancy and a reluctance to subject the patient to diagnostic radiology in view of fetal exposure concerns. The total maternal radiation exposure during pregnancy should be limited to less than 5 rads (chest X-ray exposure 0.2 rads).…”

Section: Discussionmentioning

confidence: 99%

Anesthesia for cesarean delivery in a patient with large anterior mediastinal tumor presenting as intrathoracic airway compression

et al. 2014

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Anterior mediastinal mass is a rare pathology that presents considerable anesthetic challenges due to cardiopulmonary compromise. We present a case that was referred to us in the third trimester of pregnancy with severe breathlessness and orthopnea. An elective cesarean delivery was performed under combined spinal epidural anesthesia with a favorable outcome. We discuss the perioperative considerations in these patients with a review of the literature.

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“…MMS is defined as acute right ventricular failure secondary to vascular compression after positive pressure ventilation 1 2. It was described in the 1970s by Dr Bittar who found a high-risk of perioperative morbidity and mortality in association with general anaesthesia and the airway management of patients with anterior mediastinal mass 3…”

Section: Discussionmentioning

confidence: 99%

“…Predictors of perioperative complications concerning respiratory or circulatory collapse in patients with a mediastinal mass are CT findings of ≥50% tracheal compression or ≥130 cm 3 mass volume, presence of pleural effusion or pericardial effusion, presence of superior vena cava compression, pulmonary artery compression on one side, and atelectasis on the other side peak expiratory flow rate ≤40% of the predicted value, and an obstructive or mixed pattern of pulmonary function test 1 6…”

Section: Discussionmentioning

confidence: 99%

A 21-year-old woman with mediastinal mass and cardiac arrest

et al. 2013

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Perioperative Management of the Pregnant Patient with an Anterior Mediastinal Mass

Cited by 9 publications

References 36 publications

Anticipated difficult airway during obstetric general anaesthesia: narrative literature review and management recommendations.

Anticipated difficult airway during obstetric general anaesthesia: narrative literature review and management recommendations.

Anesthesia for cesarean delivery in a patient with large anterior mediastinal tumor presenting as intrathoracic airway compression

A 21-year-old woman with mediastinal mass and cardiac arrest

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