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

Al-Sanouri, Ibrahim; Shaban, Mohammad; Alshahid, Maie; Abdulaziz, Salman

doi:10.1136/bcr-2013-009020

Cited by 3 publications

(6 citation statements)

References 6 publications

(5 reference statements)

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“…One patient experienced severe oxygen desaturation as the airway collapsed after endotracheal intubation without muscle relaxant and the operation was finally cancelled ( 12 ). Three patients died: 2 patients died from cardiopulmonary arrest as a result of ventilation failure during the anesthesia induction ( 37 , 80 ); 1 patient had cardiac arrest intraoperatively due to suddenly increased airway resistance which deteriorated to sustained ventilation failure. The patient died on postoperative day 10 ( 75 ).…”

Section: Resultsmentioning

confidence: 99%

“…By integrating the existing data of patients with mediastinal mass ( 2 , 82 , 83 ), we propose a classification to help categorize patients into three categories s of risk ( Table 2 ). A detailed preoperative multidisciplinary team (MDT) discussion is of vital importance ( 14 , 37 ).…”

Section: Discussionmentioning

confidence: 99%

“…For example, avoidance of general anesthesia (especially paralytic agents) or maintenance of SV has been recommended ( 35 , 69 ). It is a consensus to proceed with stepwise induction and avoid deep sedation ( 37 ). It has been agreed that, no single agent is superior to another one, and that any agent should be used judiciously in consideration of retaining SV.…”

Section: Discussionmentioning

confidence: 99%

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Anesthetic management of patients undergoing mediastinal mass operation

Tan

Lin²,

He³

et al. 2022

Front. Surg.

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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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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Anesthetic management of patients undergoing mediastinal mass operation

Tan

Lin²,

He³

et al. 2022

Front. Surg.

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“…The patient had a life-threatening obstructive shock due to cardiac tamponade, that was caused by an anterior mediastinal mass, and he needed urgent intervention. 5 , 8 Management of this complex condition involved a multidisciplinary joint decision-making between the anaesthetist, cardiologist, general surgeon, and emergency physician. 12 , 13 …”

Section: Discussionmentioning

confidence: 99%

“… 3 , 4 The management of such patients with overlapping conditions remains debatable, and the literature are limited to case reports. 5 , 6 , 7 , 8 …”

Section: Introductionmentioning

confidence: 99%

Worsening cardiac tamponade after pericardiocentesis in a patient with anterior mediastinum mass: a case report

Adi

Fong

Ahmad

et al. 2022

European Heart Journal - Case Reports

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Mediastinal mass is an entity with variable pathology and clinical spectrum. Anterior mediastinal mass can result in severe symptoms due to involvement of surrounding vital structures such as the great vessels, trachea-bronchial tree, and heart. We highlight a case of cardiac tamponade in a patient with an anterior mediastinal mass that was paradoxically worsened after decompressive pericardiocentesis. A 21-year-old male presented to the emergency department (ED) with breathlessness and hypotension. Bedside focused cardiac ultrasound revealed cardiac tamponade which was made worse with an anterior mediastinal mass compressing the right heart chambers. The patient was intubated for respiratory failure, following which an ultrasound-guided pericardiocentesis was performed. Unexpectedly, his hemodynamic status worsened after aspiration of 1000 ml of pericardial fluid. A repeat focused cardiac ultrasound showed reduced pericardial effusion, but worsening of right heart chambers compression by the mediastinal mass. Re-expansion of the pericardium space with 600 ml of normal saline improved the patient’s vital signs, and reduced the right heart compression. CT was deferred due to the patient’s hemodynamic instability. Despite resuscitation with fluids and initiation of vasopressor, the patient’s condition deteriorated. He succumbed to his illness due to obstructive shock causing multi-organ failure. The autopsy showed a large anterior mediastinal mass, and histopathological examination confirmed the diagnosis of lymphoma. This case demonstrated the therapeutic challenges of managing a shock patient with anterior mediastinal mass, and massive pericardial effusion causing cardiac tamponade.

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