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Anesthesia for Patients with Mediastinal Masses

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Principles and Practice of Anesthesia for Thoracic Surgery

Abstract

Patients with anterior mediastinal masses can develop major airway and cardiovascular compression under general anesthesia, which can be fatal. Patients who are symptomatic or have significant compression of these vital structures on CT scans are likely at high risk. Where possible, diagnostic procedures should be undertaken under local anesthesia. Understanding the relation of the mediastinal mass to vital cardiorespiratory structures, careful preoperative assessment of the patient, discussion with the surgeon, meticulous planning, and preparation for possible perioperative complications related to compression of the major airways and vascular structures are key to successful management. Useful strategies to consider include awake fiberoptic intubation, maintenance of spontaneous ventilation, avoidance of muscle relaxants, intubation distal to the airway compression, positioning changes, immediate availability of rigid bronchoscopy, and elective cardiopulmonary bypass in extreme cases. A careful anesthetic plan that is not irreversible is likely to result in a good outcome.

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Authors and Affiliations

  1. Department of Anesthesiology, Singapore General Hospital, Singapore, Singapore

    Chih Min Ku MBBS, M. Med

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  1. Chih Min Ku MBBS, M. Med
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Editors and Affiliations

  1. University of Toronto, Staff Anesthesiologist, Professor of Anesthesia, Toronto, M5G 2C4, Ontario, Canada

    Peter Slinger, MD, FRCPC

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Ku, C.M. (2011). Anesthesia for Patients with Mediastinal Masses. In: Slinger, MD, FRCPC, P. (eds) Principles and Practice of Anesthesia for Thoracic Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0184-2_14

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  • DOI: https://doi.org/10.1007/978-1-4419-0184-2_14

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