Anesthetic Evaluation and Perioperative Management in a Patient with New Onset Mediastinal Mass Syndrome Presenting for Emergency Surgery

Shi, David E.; Webb, Christopher; Wagner, Meredith; Dizdarevic, Anis

doi:10.1155/2011/782391

Cited by 4 publications

(3 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Some authors ( 5 , 7 , 8 , 12 , 24 , 35 , 44 , 49 , 57 ) have outlined some suggestions for the anesthetic management of mediastinal mass patients undergoing surgery. For example, avoidance of general anesthesia (especially paralytic agents) or maintenance of SV has been recommended ( 35 , 69 ).…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of patients undergoing mediastinal mass operation

Tan

Lin²,

He³

et al. 2022

Front. Surg.

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Anesthetic management of patients undergoing mediastinal mass operation

Tan

Lin²,

He³

et al. 2022

Front. Surg.

View full text Add to dashboard Cite

show abstract

“…Anesthesia induction can be accomplished with either inhalation agents or intravenous titration of ketamine with or without other intravenous agents to maintain spontaneous ventilation. Awake fiberoptic intubation is also a recommended option but the rate of success will depend on the technique and experience of the anesthesiologist [16]. Normally, bleeding from these tiny vessels is self-limiting; however, in patients with SVC syndrome, venous pressure is elevated, and bleeding may be more pronounced.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Catastrophe during Benign Mediastinal Tumor Mass Excision: A Case Report

Kumar

Persuad

Shiwalkar

2019

Cureus

View full text Add to dashboard Cite

Mature teratoma of the mediastinum poses a significant surgical challenge due to close vicinity to vital structures causing respiratory insufficiency or hemodynamic compromise. While the malignant variety of germ cell tumors (GCT) generally present with florid symptoms, benign teratomas are detected incidentally on imaging. Large teratomas presenting as mediastinal mass syndrome have additional difficulty in airway access. Herein, we report a case of a 40-year-old-female with no significant comorbidities presenting with rapidly progressing symptoms of chest pain, dyspnea, and superior vena cava (SVC) compression. Computed tomography (CT) scan of the neck and chest confirmed a large cystic lesion with marked compression of the great veins in the neck, arch of aorta, trachea, and proximal bronchial divisions. Airway access intraoperatively was done by awake fiberoptic bronchoscopy. However, sudden hypoxia and hemodynamic deterioration warranted emergency sternotomy. Adequate preoperative preparation, as well as standby extracorporeal circulatory support, led to successful and complete excision of the tumor. The patient had an uneventful recovery and extubated in the intensive care unit (ICU) the next day. Histopathology of the mass confirmed to be mature benign cystic teratoma. At six-month follow-up, the patient was completely asymptomatic without any complications. The impact of intraoperative catastrophe on the healthcare team can be immense. Inability to achieve a secure airway and the resultant hypoxia can result in permanent neurological damage. A multidisciplinary approach leading to adequate preoperative assessment, intraoperative preparedness for an emergency sternotomy with standby extracorporeal circulatory support due to the risk of mediastinal mass syndrome, were key features in the successful management of the patient.

show abstract

“…Indukcija se može postići inhalacijskim agensima ili ketaminom intravenski koji se izdvaja zbog svojih analgosedacijskih učinaka uz minimalnu depresiju disanja. [48][49][50][51] Nadalje, smatra se da je anestezija na bazi propofola, upotrijebljena u kontroliranom okruženju, sigurna i učinkovita za obavljanje kratkotrajnih bolnih postupaka u djece s onkološkim bolestima. 52 Prilikom procjene dišnog sustava djeteta ne treba zanemariti ni pitanje sindroma opstruktivne apneje u snu (OAS) jer su djeca s OAS-om podložna razvoju teških hipoksemija u poslijeoperacijskom periodu.…”

Section: Neurological -Rizici Povezani S Neurološkim Bolestima U Djeceunclassified

Assessment of Preoperative Risk in Children

2018

View full text Add to dashboard Cite

Sažetak. Prijeoperacijska procjena zdravstvenog stanja bolesnika neizostavni je dio planiranja svakog zahvata pri kojemu se bolesnik podvrgava anesteziji. Klasifi kacija fi zikalnog statusa bolesnika Američkog društva anesteziologa (engl. The American Society of Anesthesiologists-ASA) danas se rutinski rabi za procjenu rizika od anestezije i perioperacijske smrtnosti bolesnika neovisno o dobi. Međutim, kao što se anestezija u djece razlikuje od anestezije u odraslih, nužno je i u prijeanestezijskoj procjeni rizika uzeti u obzir osobitosti dječje dobi. Radi kvalitetne procjene rizika od anestezije razvili su se novi sustavi procjene rizika i specifi čne smjernice prijeanestezijske obrade u djece. Ukratko su prikazana dva nova alata za procjenu prijeanestezijskog rizika u djece: bodovni sustav PRAm (Pediatric Risk Assessment score) i sustav NARCO-SS (engl. neurological, airway, respiratory, cardiovascular, other-surgical severity). Cilj je rada kritički osvrt na postojeće smjernice procjene prijeanestezijskog rizika u djece. Prijeoperacijskom procjenom rizika i pripremom za anesteziju prilagođenom dječjoj dobi mogu se unaprijediti sigurnost i uspjeh anesteziološkog postupka u djece.

show abstract

Anesthetic Evaluation and Perioperative Management in a Patient with New Onset Mediastinal Mass Syndrome Presenting for Emergency Surgery

Cited by 4 publications

References 16 publications

Anesthetic management of patients undergoing mediastinal mass operation

Anesthetic management of patients undergoing mediastinal mass operation

Intraoperative Catastrophe during Benign Mediastinal Tumor Mass Excision: A Case Report

Assessment of Preoperative Risk in Children

Contact Info

Product

Resources

About