CT quantitation of tracheal cross-sectional area as a guide to the surgical and anesthetic management of children with anterior mediastinal masses

Shamberger, Robert; Holzman, Robert S.; Griscom, N. Thorne; Tarbell, Nancy J.; Weinstein, Howard J.

doi:10.1016/0022-3468(91)90894-y

Cited by 214 publications

(63 citation statements)

References 12 publications

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“…It is especially important to elicit a history of dyspnea, particularly if a postural component is present. Positional dyspnea or orthopnea and stridor are potentially ominous signs and may predict the degree of tracheal compression, 6 pulmonary function abnormalities, 7 and the likelihood of complications. [7][8][9][10] If postural symptoms are identified, an effort should be made to define the position(s) in which symptoms are minimized.…”

Section: Evaluation Of Riskmentioning

confidence: 99%

“…The literature is replete with examples of patients with mediastinal masses who suffered from severe or even fatal intraoperative airway compromise. Patients with a [ 50% decrease in tracheal crosssectional area (CSA) are more likely to be symptomatic 6 and suffer from perioperative complications, 8,19 whereas a tracheal CSA of [ 50% of normal appears to be associated with a low incidence of respiratory complications. 17,20 Not surprisingly, the ''safe'' lower limit of tracheal CSA varies between studies and other lower limits have been proposed.…”

Section: Tracheal Compressionmentioning

confidence: 99%

“…Il est particulièrement important d'obtenir les antécédents de dyspnée du patient, particulièrement si les symptômes comportent une composante posturale. La dyspnée ou l'orthopnée de position et le stridor sont des signes potentiellement inquiétants et pourraient être des prédicteurs du degré de compression trachéale, 6 des anomalies au niveau de la fonction pulmonaire, 7 et de la possibilité de complications. [7][8][9][10] Si des symptômes posturaux sont identifiés, il faut, dans la mesure du possible, définir la/les position(s) dans laquelle/lesquelles les symptômes sont minimisés.…”

Section: L'évaluation Préopératoireunclassified

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La prise en charge de l’anesthésie des patients avec une masse médiastinale antérieure

Blank

Souza

2011

Can J Anesth/J Can Anesth

125

104

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Purpose Many cases have been reported of hemodynamic and airway collapse induced by general anesthesia in patients with an anterior mediastinal mass. We examined the literature for predictors of perioperative risk, guidelines for preoperative investigations, and strategies for management of the patient with a mediastinal mass. Principal findings In patients with an anterior mediastinal mass, symptoms may range from none to severe and may include orthopnea, stridor, cyanosis, jugular vein distension, or superior vena cava syndrome. In limited case series, incidences of serious complications up to 20% were noted, but these are primarily pediatric studies with unclear relevance to adults. There is a paucity of evidence providing guidance on quantifying risk and planning the safe conduct of anesthesia. In the largest adult case series to date, intraoperative complications were associated only with the preoperative presence of a pericardial effusion. Postoperative complications were predicted by severe symptoms at presentation, tracheal compression of [ 50%, and a mixed obstructive-restrictive picture on pulmonary function testing. Low-risk patients tolerate conventional general anesthesia with neuromuscular blockade and positive pressure ventilation. Those at intermediate or high risk are best managed with the maintenance of spontaneous ventilation, at least initially. Cardiopulmonary bypass remains the option of last resort. Conclusions It appears prudent to avoid general anesthesia when possible for patients at the highest risk. When general anesthesia is required, a comprehensive plan must be formulated preoperatively with the surgical team. Cardiopulmonary bypass requires time for implementation, so it should be considered early and appropriate preparations should be made prior to the initiation of anesthesia.

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Section: Evaluation Of Riskmentioning

confidence: 99%

Section: Tracheal Compressionmentioning

confidence: 99%

Section: L'évaluation Préopératoireunclassified

See 1 more Smart Citation

La prise en charge de l’anesthésie des patients avec une masse médiastinale antérieure

Blank

Souza

2011

Can J Anesth/J Can Anesth

125

104

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“…Preoperatif uygulanan radyoterapi veya kortikosterid tedavisi bası semptomlarını azaltabilmesine karşın, histolojik tanı konulmasını olumsuz etkileyebilir. Bilgisayarlı tomografi sonuçlarına göre %50 üzerinde hava yolu basısı belirlenen hastalarda havayolu obstrüksiyonu gelişebileceği düşünülmeli ve eğer gerekli ise preoperatif radyoterapi veya kortikosterid tedavisi uygulanmalıdır (56). Extramediastinal kitlesi olan çocuklarda lokal anestezi ya da sedasyon yeterli gelebilir.…”

Section: Mediastinal Kitlelerunclassified

Anesthesia in Pediatric Thoracic Surgery

Sazak¹,

Alagöz²,

Şahin³

2012

Toraks Cer Bult

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“…2). Accordingly, the diagnosis was considered to be sudden asphyxia due to esophageal c h e a d u e t o c o mp r e s s i o n o f a p o s t e r i o r e n h a n c e d ma s s ( wh i t e a r r o w) , s u g g e s t i n g e s o p h a g e a l t u (12,13). However, once a patient experiences dyspnea with significant airway stenosis, even due to minor deterioration of airway stenosis, the patient could die of asphyxia unless appropriate airway securing procedures are performed (14)(15)(16) …”

Section: Case Reportmentioning

confidence: 99%