Cesarean delivery in a parturient with an anterior mediastinal mass

Ordons, Amanda L Roze des; Lee, Jason; Bader, Erin; Scheelar, Les; Achen, B; Taam, Jason; MacArthur, Roderick; Townsend, Derek R.

doi:10.1007/s12630-012-9815-4

Cited by 5 publications

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References 4 publications

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“…Particularly in a patient with a large mediastinal mass, general anesthesia can result in respiratory and hemodynamic collapse [ 10 , 11 ]. Maintaining spontaneous respiration is effective in preventing airway collapse secondary to decreased muscle tone [ 12 ].…”

Section: Case Presentationmentioning

confidence: 99%

“…Also, patients with tracheal compression of more than 50% have a risk of total airway obstruction during induction of general anesthesia [ 13 ]. For these reasons, CSEA is preferable to maintain hemodynamics because if the mediastinal mass is compressing the SVC, right ventricle, and pulmonary artery, hemodynamic collapse can occur during positive pressure ventilation [ 10 ]. To predict the risk of hemodynamic collapse, preoperative cardiovascular evaluation is necessary.…”

Section: Case Presentationmentioning

confidence: 99%

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

et al. 2017

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BackgroundSymptomatic anterior mediastinal mass in pregnancy is rare, and cesarean section for such patients poses a risk of cardiopulmonary collapse.Case presentationA 30-year-old woman at 40 weeks’ gestation complained of breathlessness and cough, and she was not able to lie supine because of respiratory distress. Computed tomography scan revealed a large anterior-superior mediastinal mass severely compressing the trachea, bilateral main bronchus, and superior vena cava. Because clinical symptoms and computed tomographic findings suggested imminent respiratory catastrophe, urgent cesarean section was planned. The patient was able to lie in the semi-recumbent position with minimal symptoms; therefore, we considered it safe to perform cesarean section with combined spinal epidural anesthesia. In the event of cardiopulmonary collapse, emergent intubation and extracorporeal membrane oxygenation were also planned. The operation was performed successfully with combined spinal epidural anesthesia. The infant was healthy, and the postoperative hospital course was uneventful.ConclusionsCombined spinal epidural anesthesia is preferable in the anesthetic management of cesarean section with symptomatic anterior mediastinal mass. A well-designed preoperative strategy can lead to favorable outcomes even in this complicated situation.

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Section: Case Presentationmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%