Use of BiPAP for safe anesthesia in a child with a large anterior mediastinal mass

Bassanezi, Betina Silvia Beozzo; Miranda, Márcio Lopes; Soares, Letícia Clemente Alvim; Aguiar, Simone S.

doi:10.1111/j.1460-9592.2011.03607.x

Cited by 14 publications

(4 citation statements)

References 5 publications

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“…Median LHS was 5 days (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). In two cases, we observed intraoperative bleeding (4.7%): one biopsy of a germ cell tumor managed thoracoscopically and one lung resection for nephroblastoma metastasis which required conversion to open surgery.…”

Section: Resultsmentioning

confidence: 94%

“…As far as it concerns the use of VATS for diagnostic procedures, MIS has been effectively used to perform mediastinal mass biopsies as well as pulmonary masses (10,13,(16)(17)(18). Reported advantages of thoracoscopy are the possibility of exploring the entire surface of the lung and pleura, and performing multiple biopsies if required (e.g., germinal tumors).…”

Section: Discussionmentioning

confidence: 99%

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The Role of Video-Assisted Thoracoscopic Surgery in Pediatric Oncology: Single-Center Experience and Review of the Literature

et al. 2021

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Aim: Video-assisted thoracoscopic surgery (VATS) has been widely used in the last decades. Nevertheless, the pros and cons of thoracoscopy vs. open surgery in pediatric oncology are still under debate. In literature, VATS has been applied for both diagnostic and ablative surgery to treat neurogenic tumors, thymic neoplasms, lung tumors and metastases, germ cell tumors, lymphoproliferative diseases, and other rare tumors. Recent reviews described excellent outcomes in pediatric oncology as well as in the treatment of adult lung cancer, with a significantly higher rate of mortality and complication in thoracotomy compared to VATS. We reviewed our experience on thoracoscopy in pediatric malignancy and compared it to the literature.Materials and Methods: This was a retrospective cohort-study of pediatric oncological patients who underwent VATS at our institution from 2007 to 2020, and a review of the recent literature on the topic.Results: A total of 43 procedures were performed on 38 oncological patients (18 males, 20 females). Median age was years 7.72 (0.35–18.6). Diagnosis: 10 neurogenic tumors, nine hematological diseases, five metastases, four lypoblastomas, three thymic pathologies, three germ cell tumors, two pleuropneumoblastomas, two myofibroblastic tumors, one myoepithelial carcinoma, one liposarcoma, and three suspected oncological mass. In three cases, a 3D model was elaborated to better plan the surgical approach. Diagnostic biopsies were 22 (51.1%), and ablative surgeries, 21 (48.9%). One neurogenic tumor was resected with the Da Vinci Robot. Median operative time was 120 min (30–420). A drain was left in place in 20 (46.5%) for a median of 4 days. Median length of hospitalization was 5 days (1–18). One case (2.3%) was converted (intraoperative bleeding). There were three post-operative complications (7.0%): one pneumonia, one pleural effusion, and one diaphragmatic paralysis (need for plication). Results were compared to recent literature, and morbidity and conversion rate were comparable to reviewed publications.Conclusion: VATS represents a valuable tool for diagnostic and therapeutic procedures in pediatric oncology. Nonetheless, it is a challenging technique that should be performed by expert surgeons on oncological and mini-invasive surgery. Three-dimensional reconstruction can optimize the pre-operative planning and guarantee a safer and more targeted treatment. Finally, the advent of robotics-assisted surgery represents a new challenge that may further implement the advantages of VATS.

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Section: Resultsmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

The Role of Video-Assisted Thoracoscopic Surgery in Pediatric Oncology: Single-Center Experience and Review of the Literature

et al. 2021

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“…Since the increased availability of fiberoptic bronchoscopy (FOB) in many institutions, awake intubation guided by FOB has become another useful option for airway management in mediastinal masses patients (especially those with airway compression). In Rajagopalan ( 32 ) and Miyauchi's view ( 51 ), LMA or bi-level positive airway pressure (BiPAP) in sedation anesthesia can be used in patients with mediastinal mass that needs an incisional biopsy while maintaining SV. It is important to adhere to the general principles of maintaining effective ventilation and hemodynamic stability during induction and maintenance of anesthesia regardless of the technique used.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of patients undergoing mediastinal mass operation

Tan

Lin²,

He³

et al. 2022

Front. Surg.

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ObjectivesTo summarize the anesthetic management of patients undergoing mediastinal mass operation.MethodsElectronic databases were searched to identify all case reports of patients undergoing mediastinal mass operation. Information such as clinical characteristics, perioperative management and patients’ outcomes were abstracted and analyzed.ResultsSeventy-seven case reports with 85 patients aging from 34 days to 81 years were included. Mediastinal masses were located in anterior (n = 48), superior (n = 15), middle (n = 9) and posterior (n = 9) mediastinum, respectively. Clinical manifestations included dyspnea (n = 45), cough (n = 29), chest or radiating pain (n = 12), swelling (n = 8), fever (n = 7) and chest distress (n = 4). Most patients (n = 75) had signs of compression or invasion of vital structures. General anesthesia (n = 76) was the most commonly used method of anesthesia. Muscle relaxants were administered in 35 patients during anesthesia induction and spontaneous respiration was maintained in 37 patients. Mediastinal mass syndrome (MMS) occurred in 39 cases. Extracorporeal circulation was utilized in 20 patients intraoperatively. Three patients experienced cardiac arrest after ventilation failure and two patients died intraoperatively and one postoperatively.ConclusionsPeri-operative management of patients undergoing mediastinal mass operation could be challenging. Pre-operative multi-disciplinary discussion, well-planned anesthetic management and pre-determined protocols for emergency situations are all vital to patient safety.

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“…42,43 General anesthesia should be avoided in patients with tracheal cross-sectional area or peak inspiratory flow rate less than 50% of predicted for age and sex, and those with less respiratory compromise can generally safely undergo general anesthesia. 44 Thoracic epidural anesthesia 45 or bilevel positive airway pressure management 46 has been used in children for open biopsies of anterior mediastinal masses. However, to our knowledge, similar attempts have not been reported for thoracoscopic surgery in children, highlighting the extreme risk of anesthesia in this population.…”

Section: Anesthesiamentioning

confidence: 99%

The Role of Thoracoscopic Surgery in Pediatric Oncology

Malkan

Loh

Fernández-Pineda

et al. 2014

Journal of Laparoendoscopic & Advanced Surgical Techniques

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The application of thoracoscopic surgical techniques to pediatric solid tumors represents an important adjunctive tool for the surgical management of childhood cancer. Nearly four decades has passed since the introduction of minimally invasive chest surgery in children, and although the adoption of minimally invasive surgery in general pediatric surgical practice is better recognized, its role in pediatric oncology is still considered a developing field. As no consensus exists regarding the use of thoracoscopy for pediatric thoracic solid tumors, the purpose of this article is to review the current literature surrounding the use of thoracoscopic interventions in pediatric oncology and examine established indications, procedures, and technologic advances.

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Use of BiPAP for safe anesthesia in a child with a large anterior mediastinal mass

Cited by 14 publications

References 5 publications

The Role of Video-Assisted Thoracoscopic Surgery in Pediatric Oncology: Single-Center Experience and Review of the Literature

The Role of Video-Assisted Thoracoscopic Surgery in Pediatric Oncology: Single-Center Experience and Review of the Literature

Anesthetic management of patients undergoing mediastinal mass operation

The Role of Thoracoscopic Surgery in Pediatric Oncology

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