Spontaneous Respiration during Thoracotomy in a Patient with a Mediastinal Mass

Sibert, Karen S.; Biondi, James W.; Hirsch, Nicholas

doi:10.1213/00000539-198709000-00019

Cited by 63 publications

(27 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Positive pressure ventilation may critically reduce already narrowed airways and cause anaesthetic gases flowing through narrowed airways to turbulate and impair gas exchange significantly. 40 In most patients with symptoms of respiratory obstruction, peripheral tissue for biopsy is usually available and a local anaesthetic technique with or without sedation should be employed. A recent report has also emphasized the importance of obtaining diagnostic tissue via mediastinoseopy in order to begin treatment while avoiding the risks of thoracotomy.…”

Section: Anaesthetic Managementmentioning

confidence: 99%

Anaesthesia for patients with mediastinal masses

1989

View full text Add to dashboard Cite

Patients with mediastinal masses may require anaesthesia for incisional or excisional biopsy, staging laparotomy and a variety of additional procedures during their course of treatment. A large mediastinal tumour, due to its mass effects, may be associated with dramatic cardiopulmonary complications including progressive airway obstruction, loss of lung volume, pulmonary artery or cardiac compression and superior vena caval obstruction, i Each of these complications can cause death during anaesthesia if not expertly handled. Providing safe anaesthesia for these patients requires an understanding of the anatomy of the region, the pathophysiology of the lesions and an appreciation of their compressive effects on vital intrathoracic structures.This review discusses the anatomy of the region, the pathology and the clinical presentations of the mediastinal lesions themselves. The preoperative evaluation and preparation of these patients is discussed, stressing the need for a thorough CT evaluation of the entire thorax. In the discussion on the anaesthetic management, we have stressed that even asymptomatic patients with mediastinal masses have the potential to develop catastrophic airway obstruction. Key words:AIRWAY: obstruction; ANAESTHESIA: thoracic; COMPLICA-"nONS: respiratory; HEART: compression; LUNG: pulmonary artery compression; trachea; SYNDROME: superior vena cava Department of Anesthesia, The Children's Hospital and the Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, U.S.A.Address correspondence to: Dr. J. Pullerits, Department of Anesthesia, The Children's Hospital, 300 Longwood Avenue, Boston, Massachusetts, USA 02115. AnatomyThe mediastinum is that portion of the thorax lying between the fight and left pleural sacs. It is bounded anteriorly by the sternum and by the bodies of the thoracic vertebrae posteriorly and extends from the thoracic inlet superiorly to the diaphragm inferiorly. The mediastinum is divided into superior and inferior regions by a plane extending from the sternal angle to the lower border of the fourth thoracic vertebra. The upper region is named the superior mediastinum and the lower region, the inferior mediastinum. The inferior mediastinum is, in turn, divided into the anterior, middle and posterior mediastina by the pericardium. Anatomical structures of major importance to the anaesthetist are found at the junction of the superior, anterior, middle and posterior mediastina. These structures include the superior vena cava, the tracheal bifurcation, the main pulmonary artery, the aortic arch and part of the superior surface of the heart. CAN J ANAESTH 1989 ! 36:6 / pp 681-S

show abstract

Section: Anaesthetic Managementmentioning

confidence: 99%

Anaesthesia for patients with mediastinal masses

1989

View full text Add to dashboard Cite

show abstract

“…Additionally, pediatric patients are known to have more collapsible airway than adults and the aforementioned technique was not examined in the pediatric population [7,8]. The anesthesia technique described in this case report was utilized in cases where airway stenting was planned and should not be inferred to other procedures such as mass biopsy or central line placements where a rigid bronchoscope and airway stent are not available [9,10].…”

Section: Discussionmentioning

confidence: 99%

Safe Anesthesia Induction in Patients with Anterior Mediastinal Mass Using Muscle Paralysis

Sarkiss¹,

Jiménez²,

Ost³

et al. 2017

J Aging Sci

View full text Add to dashboard Cite

Available reports suggest that an anterior mediastinal mass causing more than 50% narrowing of the trachea and compressing the great vessels can cause further narrowing of the airway and cardiovascular collapse after the administration of muscle relaxants. Accordingly, inhalation induction of general anesthesia or awake intubation is used to avoid the use of muscle relaxation.The following two case reports describe the stepwise safe anesthetic induction of two patients with anterior mediastinal masses using total intravenous anesthesia followed by tailored positive pressure ventilation and administration of muscle relaxant. Case 1A 68-year-old female with recurrent large B-cell lymphoma after multiple rounds of chemotherapy and palliative radiation. The patient developed progressive shortness of breath over a 3-month period. The patient also complained of a choking sensation, hoarseness, dysphagia, and orthopnea along with increasing neck size [1][2][3][4].Computed tomography showed a large anterior mediastinal mass measuring 9.3 cm. The mass encased the great vessels and the aortic arch, narrowing the tracheal luminal diameter to 7 mm (Figures 1a and 1b). The patient was scheduled for a rigid bronchoscopy for placement of tracheal stent. Preoperative assessment revealed hoarseness, audible stridor and palpable supraclavicular mass with engorgement of superficial neck veins. Pre-procedure vital signs were heart rate 116, blood pressure 109/59, respiratory rate 16, and saturation 97% on 5 L nasal cannula.Electrocardiogram showed sinus tachycardia. Pre-procedure echocardiogram showed mild concentric left ventricular hypertrophy, an ejection fraction of 45-50%, and mild global hypokinesis of the left ventricle. Consent for general anesthesia was obtained. AnesthesiaThe patient was taken to the bronchoscopy suite and was placed in a sitting position. Preoxygenation with non-rebreather facemask was started under standard American Society of Anesthesiologists monitoring. Additionally, a Bispectral index (BIS) and non-invasive arterial blood pressure monitoring were utilized. Propofol infusion at 250 µg/kg/min, and 50 µg of fentanyl were given. As the BIS reading dropped to the 60s positive pressure ventilation was initiated with tidal volume in the range of 500s ml with a peak airway pressure of 20 cm

show abstract

“…Subsequently, the laminar flow pattern cannot be resumed, resulting in ineffective ventilation of the distal airways and loss of effective gas exchange. 13) In conclusion, coexisting SVC syndrome and CAO can cause life-threatening complications at any time during anesthesia in elderly patients with lung cancer undergoing rigid bronchoscopy. Working together as a team, anesthesiologists and bronchoscopists can anticipate these complications and institute precautionary measures to assure a safe and effective intervention.…”

Section: )mentioning

confidence: 92%

“…The same degree of edema that is seen externally in the face and neck, for example, can be present in the mouth, oropharynx, hypopharynx and larynx. 13) Prompt and atraumatic insertion of the rigid bronchoscope is critical to prevent further worsening of preexisting upper airway edema related to severe SVC symdrome. By standing at the head of the patient's bed during the induction, the bronchoscopist can be ready and equipped to assure airway control and bypass the obstruction, especially in patients with tracheal lesions.…”

Section: )mentioning

confidence: 99%

Rigid Bronchoscopy for Malignant Central Airway Obstruction from Small Cell Lung Cancer Complicated by SVC Syndrome

Jung

Murgu

Colt

2011

ATCS

View full text Add to dashboard Cite

Central airway obstruction (CAO) and superior vena cava (SVC) syndrome are potentially life-threatening complications in locally advanced lung cancer. Therapeutic rigid bronchoscopy has become an critical component in the treatment of the lung cancer patients with CAO who are not surgical candidates. However, the technique may pose significant risks in patients with coexisting SVC syndrome, especially, and even more so perhaps in patients over the age of eighty. In this case report, we address the potential risks and known benefits of therapeutic bronchoscopic intervention in an 85-year-old man with small cell lung cancer who presented with acute dyspnea secondary to advanced SVC syndrome and CAO involving the lower trachea and right main bronchus. Emergent therapeutic rigid bronchoscopy resulted in a marked improvement, in dyspnea, atelectasis, and postobstructive pneumonia, allowing rapid administration of systemic chemotherapy.

show abstract

Spontaneous Respiration during Thoracotomy in a Patient with a Mediastinal Mass

Cited by 63 publications

References 0 publications

Anaesthesia for patients with mediastinal masses

Anaesthesia for patients with mediastinal masses

Safe Anesthesia Induction in Patients with Anterior Mediastinal Mass Using Muscle Paralysis

Rigid Bronchoscopy for Malignant Central Airway Obstruction from Small Cell Lung Cancer Complicated by SVC Syndrome

Contact Info

Product

Resources

About