ObjectivesTo summarize the anesthetic management of patients undergoing mediastinal mass operation.MethodsElectronic databases were searched to identify all case reports of patients undergoing mediastinal mass operation. Information such as clinical characteristics, perioperative management and patients’ outcomes were abstracted and analyzed.ResultsSeventy-seven case reports with 85 patients aging from 34 days to 81 years were included. Mediastinal masses were located in anterior (n = 48), superior (n = 15), middle (n = 9) and posterior (n = 9) mediastinum, respectively. Clinical manifestations included dyspnea (n = 45), cough (n = 29), chest or radiating pain (n = 12), swelling (n = 8), fever (n = 7) and chest distress (n = 4). Most patients (n = 75) had signs of compression or invasion of vital structures. General anesthesia (n = 76) was the most commonly used method of anesthesia. Muscle relaxants were administered in 35 patients during anesthesia induction and spontaneous respiration was maintained in 37 patients. Mediastinal mass syndrome (MMS) occurred in 39 cases. Extracorporeal circulation was utilized in 20 patients intraoperatively. Three patients experienced cardiac arrest after ventilation failure and two patients died intraoperatively and one postoperatively.ConclusionsPeri-operative management of patients undergoing mediastinal mass operation could be challenging. Pre-operative multi-disciplinary discussion, well-planned anesthetic management and pre-determined protocols for emergency situations are all vital to patient safety.

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Background: Levosimendan (LEVO) is a positive inotropic drug which could increase myocardial contractility and reduce the mortality rate in cardiac surgical patients. However, Whether LEVO is associated with postoperative bleeding and blood transfusion in cardiac surgical patients is controversial. Therefore, the current study was designed to investigate the impact of LEVO administration on bleeding and blood transfusion requirement in off-pump coronary artery bypass grafting (OPCAB) patients. Methods: In a retrospective analysis, a total of 292 patients, aged 40–87 years, undergoing elective OPCAB between January 2019 and July 2019, were divided into LEVO group ( n = 151) and Control group ( n = 141). Patients in LEVO group continuously received LEVO at a rate of 0.1–0.2 μg kg−1 min−1 after anesthesia induction until 24 hours after OPCAB or patients in Control group received no LEVO. The primary outcome was postoperative chest drainage volume. The secondary outcomes were reoperation for postoperative bleeding, transfusion requirement of red blood cells (RBCs), fresh frozen plasma (FFP) and platelet concentrate (PC), etc. Comparisons of two groups were performed with the Student’s t-test or Wilcoxon-Mann-Whitney test. Results: There was no significant difference with respect to chest drainage volume ((956.29 ± 555.45) ml vs (1003.19 ± 572.25) ml, p = 0.478) and the incidence of reoperation for postoperative bleeding (1.32% vs 1.42%, p = 0.945) between LEVO group and Control group. The transfusion incidence and volume of allogeneic RBCs, FFP, and PC were comparable between two groups. Conclusions: LEVO administration was neither associated with more postoperative blood loss nor increased allogeneic blood transfusion requirement in OPCAB patients.