Anaesthesia for Emergency Caesarean Section in a Patient with Large Anterior Mediastinal Tumour Presenting as Intrathoracic Airway Compression and Superior Vena Cava Obstruction

Chiang, James C. S.; Irwin, Michael G.; Hussain, Alia; Tang, Yee Kwan; Hiong, Y. T.

doi:10.1155/2010/708481

Cited by 11 publications

(7 citation statements)

References 15 publications

(14 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The study found that the incidence of cancer diagnosed either before or during pregnancy at their institution was 0.1%. This finding is consistent with the prevalence previously reported by a major anesthesia text [2] and quoted in other publications [4,5]. Of note, Tharmaratnam and Balki also found no difference in the frequency of malignancy diagnoses made before pregnancy as compared with during pregnancy.…”

supporting

confidence: 92%

“…Although this case report provided no description of the patient's anesthetic care, the value of multidisciplinary patient management was emphasized in the article. Chiang et al [5] reported on a 34 year old woman at 34 weeks' gestation who was admitted with respiratory distress. A chest radiograph and computed tomography scan of the thorax showed an anterior mediastinal mass with extension into the left hemithorax and compression of the airway, heart, and superior vena cava.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Cancer and pregnancy: a difficult combination requiring multidisciplinary care

McCoun

Fragneto

2012

Journal of Clinical Anesthesia

View full text Add to dashboard Cite

supporting

confidence: 92%

mentioning

confidence: 99%

Cancer and pregnancy: a difficult combination requiring multidisciplinary care

McCoun

Fragneto

2012

Journal of Clinical Anesthesia

View full text Add to dashboard Cite

“…Initial diagnosis of a mediastinal mass in pregnancy is difficult to establish due to similarities of presenting signs and symptoms that mimic normal pregnancy [7], as well as the desire to avoid unnecessary radiographic imaging during pregnancy [8]. Anterior mediastinal masses compete with underlying vital structures including the heart, major vessels and airways, and can lead to obstruction of these airways, as well as main pulmonary arteries, atria, and superior vena cava.…”

Section: Discussionmentioning

confidence: 99%

Dyspnea in Pregnancy: A Case Report of a Third Trimester Mediastinal Mass in Pregnancy

2018

View full text Add to dashboard Cite

Patient: Female, 34Final Diagnosis: Primary mediastinal b cell lymphomaSymptoms: Cough • shortness of breathMedication: —Clinical Procedure: Cesarean deliverySpecialty: Obstetrics and GynecologyObjective:Rare co-existance of disease or pathologyBackground:Dyspnea in pregnancy is common and attributable to a variety of etiologies including normal physiology. The obstetric provider is challenged with distinguishing between physiologic versus pathologic dyspnea.Case Report:A 31-year-old G2 P1001 female at 34 weeks gestation presented with dyspnea, tachycardia, and inability to lie supine. Imaging revealed a large heterogeneous anterior mediastinal mass (14.8×11.5 cm). Multidisciplinary coordinated care led to diagnosis of B cell lymphoma, delivery via cesarean section under regional anesthesia in steep Trendelenberg position, followed by chemotherapy postpartum.Conclusions:Dyspnea in pregnancy is common but might represent underlying pathology. While an obstetrician is knowledgeable of physiologic pregnancy changes, he or she should remain vigilant for underlying pathologic causes of dyspnea, including malignancy. Anterior mediastinal masses propose unique anesthetic challenges including respiratory impairment and cardiopulmonary collapse requiring collaborative care and planning.

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

Anaesthesia for Emergency Caesarean Section in a Patient with Large Anterior Mediastinal Tumour Presenting as Intrathoracic Airway Compression and Superior Vena Cava Obstruction

Cited by 11 publications

References 15 publications

Cancer and pregnancy: a difficult combination requiring multidisciplinary care

Cancer and pregnancy: a difficult combination requiring multidisciplinary care

Dyspnea in Pregnancy: A Case Report of a Third Trimester Mediastinal Mass in Pregnancy

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

Contact Info

Product

Resources

About