Anesthetic management of a large mediastinal mass for tracheal stent placement

Rajagopalan, Suman; Harbott, Mark; Ortiz, Jaime; Bandi, Venkata

doi:10.1016/j.bjane.2014.01.009

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…Since the increased availability of fiberoptic bronchoscopy (FOB) in many institutions, awake intubation guided by FOB has become another useful option for airway management in mediastinal masses patients (especially those with airway compression). In Rajagopalan ( 32 ) and Miyauchi's view ( 51 ), LMA or bi-level positive airway pressure (BiPAP) in sedation anesthesia can be used in patients with mediastinal mass that needs an incisional biopsy while maintaining SV. It is important to adhere to the general principles of maintaining effective ventilation and hemodynamic stability during induction and maintenance of anesthesia regardless of the technique used.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

Anesthetic management of patients undergoing mediastinal mass operation

Tan

Lin²,

He³

et al. 2022

Front. Surg.

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“…It has been previously observed that stent introduction under general anesthesia is more safe for the patient if general anesthesia can be applied since many patients with malignancy have COPD or pleural effusion or other contraindications 14. Hemorrhage can be more efficiently managed under general anesthesia, either with a coagulation equipment or with a hemostatic balloon, as there is always the case where intubation might be needed 15. A rigid bronchoscope is an excellent piece of equipment in order to introduce several rigid forceps or other equipment necessary for debulking or hemostasis 16.…”

Section: Discussionmentioning

confidence: 99%

A retrograde y-stenting of the trachea for treatment of mediastinal fistula in an unusual situation

Hohenforst-Schmidt¹,

Steinheimer²,

Schneider³

et al. 2017

TCRM

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IntroductionStents have been used for quite some time for the treatment of benign and malignant airway stenosis. Silicon stents are preferred for benign situations, whereas metallic self-expanding stents are preferred for malignant comorbidities.Patient and methodsIn general, stents can be placed in different approach directions, although in pulmonary medicine it is logical to apply only antegrade techniques – until now. A 63-year-old patient, 168 cm height and 53 kg weight on referral, suffered chronical diseases. The patient was diagnosed with a papillary thyroid carcinoma in 1989, which was treated by resection and radiotherapy. In the following years, she developed a stenosis of the esophagus. The decision to try endobronchial stenting was made upon the plan to close that fistula with a pedicled omentum majus replacement through the diaphragmal opening of the esophagus. This surgical plastic needed an abutment and a secured continuous airway replacement above the tracheostoma level. A Freitag stent (FS), 11 cm in length (110–25–40) and an inner diameter of 13 mm, was placed successfully retrograde into the trachea and completely bridged the big fistula. Unfortunately the patient passed away due to pulmonary infections after several weeks.DiscussionIn this case report, a successful but unusual case of retrograde stent placement of a modified FS is presented.

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“…Perioperative management of patients with mediastinal masses still poses a challenge for the anesthesiologist as the use of general anesthesia can be associated with acute perioperative cardiorespiratory compromise resulting from the mass collapsing on the trachea, cardiac chambers, pulmonary veins, or the superior vena cava [3].…”

Section: Introductionmentioning

confidence: 99%

Procedural Sedation with Dexmedetomidine for Anterior Mediastinotomy in a High-Risk Patient

Pratas

Aires

Silva

et al. 2022

Case Reports in Anesthesiology

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Perioperative management of patients with mediastinal masses still poses a challenge for the anesthesiologist, as the use of general anesthesia can be associated with acute perioperative cardiorespiratory impairment resulting from the mass collapsing on the airway or vascular structures. Dexmedetomidine can be used for procedural sedation due to its reversible sedative and anxiolytic properties with dose-dependent effects, while not interfering with ventilatory drive. These features are of particular interest for the perioperative management of patients with large anterior mediastinal masses. In this case, we report our anesthetic management of a 22-year-old male scheduled for anterior mediastinotomy, with a large anterior mediastinal mass, with 50% distal tracheal compression and marked collapse of the superior vena cava and brachiocephalic trunk. In the operation theatre, an infusion of dexmedetomidine was titrated to adequate anesthetic depth while keeping the patient under spontaneous ventilation with oxygen (O2) supplementation and local anesthetic infiltration of the surgical site. Mediastinotomy lasted for about 30 minutes, during which the patient maintained appropriate ventilation and hemodynamic stability. No adverse events occurred perioperatively. Diagnostic procedures such as mediastinotomy for tissue biopsy are necessary to achieve a histological diagnosis. High-risk patients may present with severe postural symptoms, stridor, cyanosis, and radiological evidence of more than 50% airway obstruction, tracheal compression with bronchial compression, pericardial effusion, or superior vena cava syndrome. Relaxation of bronchial smooth muscles under general anesthesia increases the risk of airway obstruction. In this case, with the use of dexmedetomidine combined with local anesthetic infiltration, spontaneous ventilation and muscle tone were preserved, decreasing the probability of intraoperative complications. It is our opinion that dexmedetomidine combined with local anesthetic infiltration can be a safe option for procedural sedation in patients presenting with high-risk anterior mediastinal masses for mediastinotomy.

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Anesthetic management of a large mediastinal mass for tracheal stent placement

Cited by 3 publications

References 11 publications

Anesthetic management of patients undergoing mediastinal mass operation

Anesthetic management of patients undergoing mediastinal mass operation

A retrograde y-stenting of the trachea for treatment of mediastinal fistula in an unusual situation

Procedural Sedation with Dexmedetomidine for Anterior Mediastinotomy in a High-Risk Patient

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