Total Airway Occlusion and Superior Vena Cava Syndrome in a Child with an Anterior Mediastinal Tumor

Northrip, Dennis R.; Bohman, Bradford K.; Tsueda, Kentaro

doi:10.1213/00000539-198610000-00019

Cited by 77 publications

(30 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…If the results of these tests are non contributory and the clinical state of the patient is critical, the treatment must not be delayed [8]. Thoracotomy and mediastinal biopsy are fraught with danger because of serious anaesthetic risks and risk of massive hemorrhage from injury to dilated collateral veins [11]. In contrast, venography was found to be safe and not to have any major complications [12].…”

Section: Discussionmentioning

confidence: 99%

Superior vena cava syndrome in children

Gupta

Ambati

Pant

et al. 2008

Indian J Hematol Blood Transfus

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Superior vena cava syndrome in children

Gupta

Ambati

Pant

et al. 2008

Indian J Hematol Blood Transfus

View full text Add to dashboard Cite

Section: Casementioning

confidence: 99%

“…The patient developed progressive shortness of breath over a 3-month period. The patient also complained of a choking sensation, hoarseness, dysphagia, and orthopnea along with increasing neck size [1][2][3][4].Computed tomography showed a large anterior mediastinal mass measuring 9.3 cm. The mass encased the great vessels and the aortic arch, narrowing the tracheal luminal diameter to 7 mm (Figures 1a and 1b).…”

mentioning

confidence: 99%

Safe Anesthesia Induction in Patients with Anterior Mediastinal Mass Using Muscle Paralysis

Sarkiss¹,

Jiménez²,

Ost³

et al. 2017

J Aging Sci

View full text Add to dashboard Cite

Available reports suggest that an anterior mediastinal mass causing more than 50% narrowing of the trachea and compressing the great vessels can cause further narrowing of the airway and cardiovascular collapse after the administration of muscle relaxants. Accordingly, inhalation induction of general anesthesia or awake intubation is used to avoid the use of muscle relaxation.The following two case reports describe the stepwise safe anesthetic induction of two patients with anterior mediastinal masses using total intravenous anesthesia followed by tailored positive pressure ventilation and administration of muscle relaxant. Case 1A 68-year-old female with recurrent large B-cell lymphoma after multiple rounds of chemotherapy and palliative radiation. The patient developed progressive shortness of breath over a 3-month period. The patient also complained of a choking sensation, hoarseness, dysphagia, and orthopnea along with increasing neck size [1][2][3][4].Computed tomography showed a large anterior mediastinal mass measuring 9.3 cm. The mass encased the great vessels and the aortic arch, narrowing the tracheal luminal diameter to 7 mm (Figures 1a and 1b). The patient was scheduled for a rigid bronchoscopy for placement of tracheal stent. Preoperative assessment revealed hoarseness, audible stridor and palpable supraclavicular mass with engorgement of superficial neck veins. Pre-procedure vital signs were heart rate 116, blood pressure 109/59, respiratory rate 16, and saturation 97% on 5 L nasal cannula.Electrocardiogram showed sinus tachycardia. Pre-procedure echocardiogram showed mild concentric left ventricular hypertrophy, an ejection fraction of 45-50%, and mild global hypokinesis of the left ventricle. Consent for general anesthesia was obtained. AnesthesiaThe patient was taken to the bronchoscopy suite and was placed in a sitting position. Preoxygenation with non-rebreather facemask was started under standard American Society of Anesthesiologists monitoring. Additionally, a Bispectral index (BIS) and non-invasive arterial blood pressure monitoring were utilized. Propofol infusion at 250 µg/kg/min, and 50 µg of fentanyl were given. As the BIS reading dropped to the 60s positive pressure ventilation was initiated with tidal volume in the range of 500s ml with a peak airway pressure of 20 cm

show abstract

“…Sudden respiratory obstruction can happen at any stage of the anaesthetic. It most commonly occurs after administration of a muscle relaxant and tracheal intubation [11][12][13][14][15], but problems have also been encountered during inhalation induction [16,17], after reversal of neuromuscular blockade and tracheal tube withdrawal [18,19] and in the recovery room [20]. Difficulty in inflation of the lungs is most probably due to the change in lung mechanics which occurs during Anaesthesia, 1999 ................................................................................................................................................................................................................................................ anaesthesia, and particularly after administration of a muscle relaxant.…”

Section: Lower Tracheal and Bronchial Obstructionmentioning

confidence: 99%