Mediastinal Hodgkin's disease: A possible danger for intubation anesthesia

Piro, Anthony J.; Weiss, Donald R.; Hellman, Samuel

doi:10.1016/0360-3016(76)90006-7

Cited by 105 publications

(26 citation statements)

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“…The incidence of such complications in a pediatric population is approximately 7-20% intraoperatively and approximately 18% postoperatively [2][3][4][5][6]. Because these were observations made in a pediatric population, it is difficult to project this into the adult population [7].…”

Section: Discussionmentioning

confidence: 96%

Dexmedetomidine for anesthetic management of anterior mediastinal mass

et al. 2010

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Anesthetic management of anterior mediastinal masses (AMM) is challenging. We describe the successful anesthetic management of two patients with AMM in which dexmedetomidine was used at supra-sedative doses. Our first case was a 41-year-old man who presented with a 10 x 9 x 11 cm AMM, a pericardial effusion, compression of the right atrium, and superior vena cava syndrome. He had severe obstruction of the right mainstem bronchus, distal trachea with tumor compression, and endobronchial tumor invasion. Our second case was a 62-year-old man with tracheal and bronchial obstruction secondary to a recurrent non-small-cell lung cancer mediastinal mass. Both patients were scheduled for laser tumor debulking and treatment of the tracheal compression with a Y-stent placed through a rigid bronchoscope. Both patients were fiberoptically intubated awake under sedation using a dexmedetomidine infusion, followed by general anesthesia (mainly using higher doses of dexmedetomidine), thus maintaining spontaneous ventilation and avoiding muscle relaxation during a very stimulating procedure. The amnestic and analgesic properties of dexmedetomidine were particularly helpful. Maintaining spontaneous ventilation with dexmedetomidine as almost the sole anesthetic could be very advantageous and may reduce the risk of complete airway obstruction in the anesthetic management of AMMs.

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Section: Discussionmentioning

confidence: 96%

Dexmedetomidine for anesthetic management of anterior mediastinal mass

et al. 2010

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“…6 Other complications of intubation or attempted intubation in this setting include postobstructive pulmonary edema 7 and death. 5 ' 8 · 9 In our case, steroids or empirical radiation therapy were considered initial temporary measures to avoid tracheotomy, but were dismissed. We believed the edema associated with radiation therapy would exac erbate the patient's airway obstruction and precipitate a catastrophe.…”

Section: Discussionmentioning

confidence: 96%

Extrinsic Tracheal Compression from an Anterior Mediastinal Mass in an Adult: The Multidisciplinary Management of the Airway Emergency

Petruzzelli

deVries

Johnson

et al. 1990

Otolaryngol.--head neck surg.

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Intrathoracic trachéal obstruction from an anterior me diastinal mass presents a complex and potentially lethal problem in managing the airway and providing adequate tissue oxygénation. Descriptions of the management and complications of adults with mediastinal masses causing extrinsic tracheobronchial compression are rare in the otolaryngologic literature. We present our multidisciplinary approach to a patient with a large anterior mediastinal mass and an unstable airway and review the management principles for patients with extrinsic trachea! compression. CASE REPORTA 33-year-old woman was transferred to the Eye and Ear Hospital of Pittsburgh by helicopter for emergency airway management. A gradually enlarging mass in the neck had been present approximately 2 months. The review of systems was remarkable for orthopnea, progressive dysphagia, dys pnea, and tachypnea, which were exacerbated when the woman was supine. Her dyspnea and hoarseness had wors ened in the past few days.Physical examination revealed a large firm mass in the anterior neck, filling the suprastemal fossa, extending supe riorly 4 cm. Hemoglobin saturation by pulse oximetry was 93% while breathing 40% oxygen by face mask. There was tachypnea to a rate of 36 and the patient reported increasing respiratory fatigue. The lungs were clear, with bilaterally 484 decreased breath sounds, and the remainder of the physical examination was normal.Computed tomography obtained at the initial presentation ( Fig. 1) showed a large anterior mediastinal mass extending into the neck. The inferior limit of the lesion was 3 cm superior to the carina. The trachéal lumen was narrowed in the an terior/posterior dimension. At the point of maximum nar rowing, the anterior wall touched the posterior wall, creating 3-mm and 4-mm airway channels; one on each side of the trachea. There was definite compression of the trachea by tumor; however, invasion through the trachea! wall and pen etration into the lumen could not be excluded at the point of maximum narrowing.In view of the patient's impending respiratory collapse, the decision was made to stabilize the airway. It was believed the site of the lesion made conventional endotracheal intu bation difficult, and placed the patient at high risk for com plete obstruction should it fail. It was decided the airway would be secured with the ventilating bronchoscope and tracheostomy and biopsy performed.Before endoscopy, under local anesthesia, the patient's right femoral artery and vein were isolated and prepared for extracorporal membrane oxygénation. With the groin vessels exposed and cannulae prepared, the patient was given general anesthesia by rapid sequence induction. The rigid ventilating bronchoscope was passed beyond the area of compression and the patient was easily ventilated. There was no evidence of erosion or extension of tumor into the trachéal lumen.A tracheostomy was performed over the bronchoscope and the tracheostomy tube was passed beyond the area of compres sion. At operation, a large firm tumor was found ex...

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“…Some authors 1 ,4 -6 emphasize the importance of maintaining spontaneous ventilation during induction of anesthesia. Bittar" and Piro et al 7 recommend radiation to mediastinal tumors in patients' with Hodgkin's disease prior to endotracheal anesthesia to prevent life-threatening airway complications.…”

Section: Discussionmentioning

confidence: 98%