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Dexmedetomidine for anesthetic management of anterior mediastinal mass

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Abstract

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 × 9 × 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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Acknowledgments

Supported by internal funds. Dr Basem Abdelmalak receives a research grant from Aspect Medical (Newton, MA, USA) in support of other research projects.

Conflict of interest statement

Dr. Abdelmalak recently received a one time honorarium from Hospira, Inc.

Author information

Authors and Affiliations

  1. Section of Anesthesia for Bronchoscopic Surgery, Departments of General Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA

    Basem Abdelmalak

  2. Anesthesiology Institute, Cleveland Clinic, Cleveland, USA

    Nicholas Marcanthony & Joseph Abdelmalak

  3. Center for Major Airway Disease, Respiratory Institute and Transplant Center, Cleveland Clinic, Cleveland, USA

    Michael S. Machuzak

  4. Section of Bronchoscopy, Respiratory Institute and Transplant Center, Cleveland Clinic, Cleveland, USA

    Thomas R. Gildea

  5. Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA

    D. John Doyle

  6. Department of General Anesthesiology/E31, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Basem Abdelmalak

Authors
  1. Basem Abdelmalak
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  2. Nicholas Marcanthony
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  3. Joseph Abdelmalak
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  4. Michael S. Machuzak
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  5. Thomas R. Gildea
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  6. D. John Doyle
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Correspondence to Basem Abdelmalak.

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Abdelmalak, B., Marcanthony, N., Abdelmalak, J. et al. Dexmedetomidine for anesthetic management of anterior mediastinal mass. J Anesth 24, 607–610 (2010). https://doi.org/10.1007/s00540-010-0946-x

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  • DOI: https://doi.org/10.1007/s00540-010-0946-x

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