Pulmonary function is compromised in children with mediastinal lymphoma

King, Denis R.; Patrick, Laura E; Ginn‐Pease, Margaret E.; McCoy, Karen; Klopfenstein, Kathryn J.

doi:10.1016/s0022-3468(97)90197-4

Cited by 145 publications

(80 citation statements)

References 8 publications

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“…It is especially important to elicit a history of dyspnea, particularly if a postural component is present. Positional dyspnea or orthopnea and stridor are potentially ominous signs and may predict the degree of tracheal compression, 6 pulmonary function abnormalities, 7 and the likelihood of complications. [7][8][9][10] If postural symptoms are identified, an effort should be made to define the position(s) in which symptoms are minimized.…”

Section: Evaluation Of Riskmentioning

confidence: 99%

“…Positional dyspnea or orthopnea and stridor are potentially ominous signs and may predict the degree of tracheal compression, 6 pulmonary function abnormalities, 7 and the likelihood of complications. [7][8][9][10] If postural symptoms are identified, an effort should be made to define the position(s) in which symptoms are minimized. Cardiovascular symptoms may result from compression of the SVC, 11 pulmonary arteries, 2,12,13 or the heart itself.…”

Section: Evaluation Of Riskmentioning

confidence: 99%

“…26 Mediastinoscopy and thoracoscopy can also be performed under local anesthesia in motivated patients. 27,28 The avoidance of general anesthesia and the use of local anesthesia alone or in combination with sedation has been reported in clinical series of adults 8 and children 7,10 with mediastinal masses.…”

Section: Anesthesia For Diagnostic Proceduresmentioning

confidence: 99%

“…Il est particulièrement important d'obtenir les antécédents de dyspnée du patient, particulièrement si les symptômes comportent une composante posturale. La dyspnée ou l'orthopnée de position et le stridor sont des signes potentiellement inquiétants et pourraient être des prédicteurs du degré de compression trachéale, 6 des anomalies au niveau de la fonction pulmonaire, 7 et de la possibilité de complications. [7][8][9][10] Si des symptômes posturaux sont identifiés, il faut, dans la mesure du possible, définir la/les position(s) dans laquelle/lesquelles les symptômes sont minimisés.…”

Section: L'évaluation Préopératoireunclassified

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

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Souza

2011

Can J Anesth/J Can Anesth

128

104

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Purpose Many cases have been reported of hemodynamic and airway collapse induced by general anesthesia in patients with an anterior mediastinal mass. We examined the literature for predictors of perioperative risk, guidelines for preoperative investigations, and strategies for management of the patient with a mediastinal mass. Principal findings In patients with an anterior mediastinal mass, symptoms may range from none to severe and may include orthopnea, stridor, cyanosis, jugular vein distension, or superior vena cava syndrome. In limited case series, incidences of serious complications up to 20% were noted, but these are primarily pediatric studies with unclear relevance to adults. There is a paucity of evidence providing guidance on quantifying risk and planning the safe conduct of anesthesia. In the largest adult case series to date, intraoperative complications were associated only with the preoperative presence of a pericardial effusion. Postoperative complications were predicted by severe symptoms at presentation, tracheal compression of [ 50%, and a mixed obstructive-restrictive picture on pulmonary function testing. Low-risk patients tolerate conventional general anesthesia with neuromuscular blockade and positive pressure ventilation. Those at intermediate or high risk are best managed with the maintenance of spontaneous ventilation, at least initially. Cardiopulmonary bypass remains the option of last resort. Conclusions It appears prudent to avoid general anesthesia when possible for patients at the highest risk. When general anesthesia is required, a comprehensive plan must be formulated preoperatively with the surgical team. Cardiopulmonary bypass requires time for implementation, so it should be considered early and appropriate preparations should be made prior to the initiation of anesthesia.

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Section: Evaluation Of Riskmentioning

confidence: 99%

Section: Evaluation Of Riskmentioning

confidence: 99%

Section: Anesthesia For Diagnostic Proceduresmentioning

confidence: 99%

Section: L'évaluation Préopératoireunclassified

See 2 more Smart Citations

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

Blank

Souza

2011

Can J Anesth/J Can Anesth

128

104

View full text Add to dashboard Cite

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“…The incidence of such complications in a pediatric population is approximately 7-20% intraoperatively and approximately 18% postoperatively [2][3][4][5][6]. Because these were observations made in a pediatric population, it is difficult to project this into the adult population [7].…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine for anesthetic management of anterior mediastinal mass

et al. 2010

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Anesthetic management of anterior mediastinal masses (AMM) is challenging. We describe the successful anesthetic management of two patients with AMM in which dexmedetomidine was used at supra-sedative doses. Our first case was a 41-year-old man who presented with a 10 x 9 x 11 cm AMM, a pericardial effusion, compression of the right atrium, and superior vena cava syndrome. He had severe obstruction of the right mainstem bronchus, distal trachea with tumor compression, and endobronchial tumor invasion. Our second case was a 62-year-old man with tracheal and bronchial obstruction secondary to a recurrent non-small-cell lung cancer mediastinal mass. Both patients were scheduled for laser tumor debulking and treatment of the tracheal compression with a Y-stent placed through a rigid bronchoscope. Both patients were fiberoptically intubated awake under sedation using a dexmedetomidine infusion, followed by general anesthesia (mainly using higher doses of dexmedetomidine), thus maintaining spontaneous ventilation and avoiding muscle relaxation during a very stimulating procedure. The amnestic and analgesic properties of dexmedetomidine were particularly helpful. Maintaining spontaneous ventilation with dexmedetomidine as almost the sole anesthetic could be very advantageous and may reduce the risk of complete airway obstruction in the anesthetic management of AMMs.

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