Anesthetic management of patients undergoing mediastinal mass operation

Abstract

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.

Challenges and pitfalls in the perioperative management of mediastinal mass syndrome: an up-to-date review

“…This decreases cross-sectional area (CSA) and increases external pressure on the airway. Central blood volume expansion can also increase tumor size due to improved perfusion [1,3,7].…”

“…During anesthesia induction, factors such as lung volume reduction, decreased smooth muscle tone in larger airways, diaphragmatic paralysis, loss of chest muscle tone, and controlled ventilation without spontaneous breathing contribute to respiratory complications [3,7]. These complications include decreased tracheobronchial diameter, increased airway compressibility, elimination of transpleural pressure gradient, loss of airway structural support, pref-erential ventilation of poorly perfused lung segments, resulting in atelectasis, ventilation-perfusion mismatch, and increased shunt formation [8][9][10].…”

“…These complications include decreased tracheobronchial diameter, increased airway compressibility, elimination of transpleural pressure gradient, loss of airway structural support, pref-erential ventilation of poorly perfused lung segments, resulting in atelectasis, ventilation-perfusion mismatch, and increased shunt formation [8][9][10]. Postoperatively, airway obstruction can occur due to surgical complications or tissue edema, especially in patients with incomplete recovery or postoperative pain [1,3,7].…”

“…Compression can lead to cardiac rhythm disturbances, syncope, reduced pulmonary blood flow, and compromised venous return. General anesthesia administration may unmask symptoms, and large tumors can directly impinge on the heart, causing arrhythmias or low cardiac output [3,7].…”

“…While CT scanning excels in anatomical delineation, MRI demonstrates superior sensitivity in differentiating soft tissues and defining tissue boundaries [7]. Fluorodeoxyglucose positron emission tomography (FDG-PET) plays an increasingly important role in diagnosing, staging, and assessing prognosis of mediastinal tumors [11], but its contribution to anatomical evaluation of the mediastinum is limited.…”