Asymptomatic undetected mediastinal mass: A death during ambulatory anesthesia

Viswanathan, Susheela; Campbell, Carol E.; Cork, Randall C.

doi:10.1016/0952-8180(94)00028-3

Cited by 36 publications

(33 citation statements)

References 19 publications

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“…Other case reports have described a rapid preoperative progression of disease in similar cases, 12,22 which could explain the surprising new findings of the TEE in this case. A recent retrospective study indicated that pericardial effusion is an independent risk factor associated with hemodynamic collapse after induction in patients with mediastinal masses.…”

Section: Intraoperative Teesupporting

confidence: 64%

Patient with Posterior Mediastinal Mass Requiring Urgent Cardiopulmonary Bypass

Anderson¹,

Dimitrova

Awad

2011

Anesthesiology

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HE literature on anesthetic concerns and perioperative care of patients with mediastinal masses has focused almost exclusively on anterior mediastinal masses. Posterior mediastinal masses traditionally have been suggested to carry a low risk of anesthetic implications. 1 We present the case of a patient with a posterior mediastinal mass who experienced hemodynamic and respiratory decompensation upon induction of general anesthesia and required urgent transition to cardiopulmonary bypass (CPB).Our case illustrates the importance of real-time imaging provided by transesophageal echocardiography (TEE) in explaining the etiology of intractable hemodynamic instability and a new finding of significant pericardial and left pleural effusion not seen on preoperative imaging. TEE made clear the urgent need to initiate CPB because it revealed a near total compression of the left atrium, which was obstructing delivery of volume to the left ventricle. In addition, this case demonstrates the inadequacy of "stand-by" CPB and the need for every institution to establish an interdisciplinary team to develop, before surgery, a formal plan for the perioperative care of patients with mediastinal masses. CASE REPORTA 45-yr-old, previously healthy woman was transferred to our facility for further management of her mediastinal mass. Six weeks before this admission, she had presented to her primary care provider with shortness of breath, cough, and intermittent low-grade fever. At that time, she received a clinical diagnosis of pneumonia and was prescribed a course of antibiotics and corticosteroids. Upon follow-up, her presenting symptoms had not improved, and she was experiencing dysphagia and right-side chest pain. A chest radiogram showed a large mediastinal mass.Subsequent computed tomography scanning ( fig. 1A and 1B) showed a 17-cm ϫ 15-cm ϫ 13-cm posterior mediastinal mass extending from the lateral right hemidiaphragm to the left upper chest wall. The scan showed that the mass displaced the trachea, mainstem bronchi, and right lung and widely splayed the tracheal carina. External compression of the airway was minimal, and at no point was the lumen caliber of the trachea or mainstem bronchi diminished significantly. A significant right pleural effusion was present, and a small amount of fluid was noted posterior to the left lung. The heart was shifted to the left, and encroachment of the left atrium by the mass could be seen. No pericardial effusion was present. Anatomic distortion and stretching of the pulmonary arteries and veins, the superior vena cava, and the proximal aorta were noted, although no significant compression of these vessels was present. There was almost complete compression of the esophagus in the thorax. No encasement or tissue invasion of thoracic structures by the mass was apparent.Upon admission to our institution, the patient was hemodynamically stable and maintaining adequate oxygen saturation on 2 l/min O 2 by nasal cannula. In an upright, 90-degree-angle sitting position, where she reported she was mos...

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Section: Intraoperative Teesupporting

confidence: 64%

Patient with Posterior Mediastinal Mass Requiring Urgent Cardiopulmonary Bypass

Anderson¹,

Dimitrova

Awad

2011

Anesthesiology

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“…Complete cardiovascular collapse and airway obstruction during or after induction of general anaesthesia are the most common life-threatening complications in patients with anterior mediastinal masses, such as large retrosternal goitre [1][2][3][4][5][6][7][8]12]. Induction of anaesthesia and initiation of positive pressure ventilation will exacerbate pre-existing SVC obstruction, while positive intrathoracic pressures will further reduce venous return from the superior vena cava, with subsequent cardiovascular collapse.…”

Section: Discussionmentioning

confidence: 99%

“…The peri-operative management of patients with mediastinal masses is challenging, with the risk of significant respiratory and cardiovascular complications [1][2][3][4][5][6][7][8][9][10]. Providing safe anaesthesia requires an understanding of the anatomy of the region, the pathophysiology of the lesion and a correct appreciation of the compressive effects on vital structures.…”

mentioning

confidence: 99%

“…Providing safe anaesthesia requires an understanding of the anatomy of the region, the pathophysiology of the lesion and a correct appreciation of the compressive effects on vital structures. Life-threatening complications, including complete airway obstruction and cardiovascular collapse, can occur at any point during anaesthesia: during induction of general anaesthesia [7,8]; during tracheal intubation [4,9]; and on initiation of positive pressure ventilation [2,10].…”

mentioning

confidence: 99%

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Temporary extracorporeal jugulosaphenous bypass for the peri‐operative management of patients with superior vena caval obstruction: a report of three cases

Radauceanu¹,

Dunn

Lagattolla

et al. 2009

Anaesthesia

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SummarySuperior vena caval obstruction from a mediastinal mass presents a significant risk to patients requiring general anaesthesia, with reports of sudden death on induction of anaesthesia, during intubation and on initiation of positive pressure ventilation. We describe the first reported use of temporary extracorporeal jugulosaphenous bypass in three cases of superior vena caval obstruction and extrinsic tracheal compression caused by massive retrosternal multinodular goitre. The bypass was performed before induction of general anaesthesia with consequent reduction in upper body venous pressure and avoidance of complications.

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“…This unique effect of ketamine is not only of academic interest, but finds important clinical application where anesthesia has to be provided without loss of FRC or chest wall tone, that is, with anterior mediastinal masses or in failing single ventricle total cavopulmonary connection (Fontan physiology) patients. Induction of general anesthesia in patients with large anterior mediastinal masses can be lethal if chest wall tone and spontaneous respiration is lost (102,485,731). With loss of chest wall tone or spontaneous respiration, the intrathoracic volume declines rapidly and considerably.…”

Section: Effects On the Acute Hypoxic Ventilatory Responsementioning

confidence: 99%

Effects of Anesthetics, Sedatives, and Opioids on Ventilatory Control

Stuth

Stucke

Zuperku

2012

Comprehensive Physiology

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This article provides a comprehensive, up to date summary of the effects of volatile, gaseous, and intravenous anesthetics and opioid agonists on ventilatory control. Emphasis is placed on data from human studies. Further mechanistic insights are provided by in vivo and in vitro data from other mammalian species. The focus is on the effects of clinically relevant agonist concentrations and studies using pharmacological, that is, supraclinical agonist concentrations are de-emphasized or excluded.

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Asymptomatic undetected mediastinal mass: A death during ambulatory anesthesia

Cited by 36 publications

References 19 publications

Patient with Posterior Mediastinal Mass Requiring Urgent Cardiopulmonary Bypass

Patient with Posterior Mediastinal Mass Requiring Urgent Cardiopulmonary Bypass

Temporary extracorporeal jugulosaphenous bypass for the peri‐operative management of patients with superior vena caval obstruction: a report of three cases

Effects of Anesthetics, Sedatives, and Opioids on Ventilatory Control

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