Anesthesia for endoscopic palliative management of a patient with a large anterior mediastinal mass

Galway, Ursula; Doyle, D. John; Gildea, Thomas R.

doi:10.1016/j.jclinane.2008.08.011

Cited by 17 publications

(14 citation statements)

References 5 publications

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“…The low density of helium allows it to play a significant clinical role in the temporary management of some forms of airway obstruction associated with gas turbulence. [39]…”

Section: Physical Properties Of Helium To Apply For Respiratory Carementioning

confidence: 99%

The use of heliox in critical care

Hashemian¹,

Fallahian²

2014

Int J Crit Illn Inj Sci

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This paper reviews the medical use of helium oxygen mixture in obstructive airway disease in patients with croup, narrow endotracheal tubes (ETTs), respiratory distress syndrome, asthma, bronchiolitis, as well as patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and acute lung injury. In addition, some other indications of heliox use and some innovative methods of ventilation applied in pediatrics and adults are presented through review of the literature of current decade. Yet, to recommend heliox use seems to require more research based on clinical practice and observation through vaster and more robust investigations.

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“…The low density of helium allows it to play a significant clinical role in the temporary management of some forms of airway obstruction associated with gas turbulence. [39]…”

Section: Physical Properties Of Helium To Apply For Respiratory Carementioning

confidence: 99%

The use of heliox in critical care

Hashemian¹,

Fallahian²

2014

Int J Crit Illn Inj Sci

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“…Moreover, the clinical efficacy of maintaining spontaneous ventilation in the context of highrisk mediastinal masses cannot be tested in a controlled fashion in human patients. Thus, clinical evidence in support of this management approach comes primarily from two lines of evidence: 1) case reports and series in which the cardiorespiratory compromise followed neuromuscular blockade and/or positive pressure ventilation; [30][31][32][33] and 2) reports 23,[34][35][36][37] and series 8,9,17,19,33 in which high-risk patients managed with spontaneous ventilation (general anesthesia or local anesthesia with sedation) avoided serious complications. Taken together with pathophysiologic principles discussed above, the bulk of available evidence supports the maintenance of spontaneous ventilation during general anesthesia.…”

Section: Review Of Evidencementioning

confidence: 99%

“…Helium-oxygen mixtures (heliox) have been used widely in patients with obstruction to promote laminar gas flow. The use of heliox has also been described in patients with critical airway obstruction from large mediastinal masses, and it may provide symptomatic improvement 37 as well as facilitate the induction of general anesthesia 36,37 and weaning from ventilator support. 40 Salutary effects of heliox with regard to laminar gas flow require high helium fractions and thus limit the inspiratory concentration of oxygen.…”

Section: Helium-oxygenmentioning

confidence: 99%

“…Les mélanges d'hélium et d'oxygène (héliox) ont été couramment utilisés chez les patients souffrant d'obstruction afin de promouvoir un débit gazeux laminaire. Le recours à l'héliox a également été décrit chez des patients présentant une obstruction critique des voies aériennes due à des masses médiastinales de grande taille, et il pourrait améliorer les symptômes 37 tout en facilitant l'induction de l'anesthésie générale 36,37 et le sevrage du soutien ventilatoire. 40 Pour bénéficier des effets salutaires de l'héliox en matière de débit gazeux laminaire, il faut des fractions élevées d'hélium, et donc limiter la concentration inspiratoire d'oxygène.…”

Section: La Ventilation Spontanéeunclassified

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

Blank

Souza

2011

Can J Anesth/J Can Anesth

125

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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“…This suggests that at least some of the difficulties reported in bag mask ventilation of these patients may be due to air trapping and consequent hyperinflation. It is also important to note that our back up plan in both cases was to insert the rigid bronchoscope under local anesthesia if difficulty in ventilation or hemodynamic instability were encountered during induction [5,6]. Additionally, pediatric patients are known to have more collapsible airway than adults and the aforementioned technique was not examined in the pediatric population [7,8].…”

Section: Discussionmentioning

confidence: 99%

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

Sarkiss¹,

Jiménez²,

Ost³

et al. 2017

J Aging Sci

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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

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Anesthesia for endoscopic palliative management of a patient with a large anterior mediastinal mass

Cited by 17 publications

References 5 publications

The use of heliox in critical care

The use of heliox in critical care

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

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

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