Anesthetic management of cesarean section in a patient with a large anterior mediastinal mass: a case report

Kusajima, K; Ishihara, Satoshi; Yokoyama, Takeshi; Katayama, Katsuyuki

doi:10.1186/s40981-017-0098-1

Cited by 8 publications

(6 citation statements)

References 14 publications

(18 reference statements)

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“…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%

“…Women who require airway surgery in addition to caesarean section, or in whom extracorporeal oxygenation methods are planned, may have to be delivered in a different unit such as a cardiothoracic centre [49,101,104,105,134,136], or an operating theatre away from the delivery suite [40].…”

Section: Discussionmentioning

confidence: 99%

“…The location of delivery was sometimes dependent on other facilities; in some patients preparations for cardiopulmonary bypass or extracorporeal membrane oxygenation were made, requiring the use of a cardiothoracic operating theatre [49,101,104,105,134,136].…”

Section: Antenatal Planningmentioning

confidence: 99%

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

2020

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

2020

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“…Patients with anterior mediastinal masses require careful perioperative planning given the risk of catastrophic airway or cardiovascular compression under general anaesthesia. Several case reports describe successful caesarean section in the parturient with such masses under combined spinal and epidural anaesthesia [ 11 , 12 ]. In this case, near complete SVC obstruction required careful haemodynamic management due to poor tolerance of either blood loss or increased intravascular fluid volume.…”

Section: Discussionmentioning

confidence: 99%

A Pregnancy Case of Primary Mediastinal Large B Cell Lymphoma with Superior Vena Cava Syndrome

Brownhalls

Gillett

Whately

et al. 2021

Case Reports in Obstetrics and Gynecology

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Primary mediastinal large B cell lymphoma (PMLBCL) is a subtype of non-Hodgkin’s lymphoma which presents rarely in pregnancy. It is an aggressive tumour that is associated with symptoms of superior vena cava (SVC) compression and airway compromise such as dyspnoea, facial and arm swelling, cough, or chest pain. Timely diagnosis is imperative to optimising patient outcomes and reducing both maternal and fetal morbidity and mortality. We report a case of a 33-year-old woman diagnosed with PMLBCL who presented at 33-week gestation with SVC obstruction to 1 mm in diameter. After multidisciplinary team discussion regarding maternal and fetal implications of management options, we proceeded to a caesarean section and initiated chemotherapy postdelivery. Lower segment caesarean section was uncomplicated, and she underwent a cycle of R-CHOEP followed by 5 cycles of DA-EPOCH. Eighteen months since the completion of the chemotherapy, the disease remained in remission.

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“…Mediastinal tumours in pregnancy are rare. 1 Timing and method of delivery together with post-partum level of care involve multidisciplinary decisions and is guided by parturient safety and foetal wellbeing. It is not clear whether general anaesthesia or regional anaesthesia is the best for caesarean delivery in a patient with large anterior mediastinal mass.…”

Section: Introductionmentioning

confidence: 99%

Anaesthetic Management for A Patient Presenting for Caesarean Delivery with A giant Thymoma – A Case Report

Petiz¹,

Lakhani²

2023

Sri Lankan J Anaesthesiol

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Presentation of a thymoma during pregnancy means that safe delivery becomes more challenging. We present a 33-year-old pregnant woman who was diagnosed with a large thymoma causing marked compression of the tracheobronchial tree and right atrium. After various multidisciplinary meetings she presented for elective caesarean section delivery at 31 weeks of gestation. A combined spinalepidural anaesthesia was performed, along with colloid pre- and co-loading, and vasopressor support. The delivery was uneventful. The possibility of catastrophic complications was foreseen. Therefore, all requirements for the possibility of airway or haemodynamic collapse were planned carefully, including the possibility of emergent cardiopulmonary bypass.

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Anesthetic management of cesarean section in a patient with a large anterior mediastinal mass: a case report

Cited by 8 publications

References 14 publications

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

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

A Pregnancy Case of Primary Mediastinal Large B Cell Lymphoma with Superior Vena Cava Syndrome

Anaesthetic Management for A Patient Presenting for Caesarean Delivery with A giant Thymoma – A Case Report

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